National Study Shows Tiotropium Bromide is Effective for Hard-to-Control Asthma
Madison, Wisconsin - An already available drug eases asthma in patients whose breathing problems persist while using inhaled corticosteroids, according to study results released this week.
University of Wisconsin-Madison researchers who were part of the trial say the ability to prescribe tiotropium bromide - which is already prescribed for chronic obstructive pulmonary disease (COPD) under the brand name Spiriva - adds another weapon to the fight against asthma.
"This is good news because sometimes patients don't respond to low doses of inhaled corticosteroids, and raising the dose doesn't always work, either," says Dr. Christine Sorkness, professor of pharmacy at the UW School of Pharmacy. "This gives physicians another option for patients whose asthma is not being adequately controlled."
Sorkness and Dr. Robert Lemanske, professor of pediatrics and medicine and head of the division of pediatric allergy, immunology, and rheumatology at the University of Wisconsin School of Medicine and Public Health, led the UW-Madison part of the trial, which enrolled 21 of the 210 adults who took part in the national study.
Study results are being released this week in the New England Journal of Medicine and at the Annual Congress of the European Respiratory Society in Barcelona, Spain.
The National Heart, Lung, and Blood Institute (NHLBI) supported the study, which compared three tactics for treating uncontrolled asthma:
- In one treatment, participants received a doubled dose of inhaled corticosteroids
- In the second, inhaled corticosteroids were supplemented by a long-acting beta-agonist (salmeterol)
- In the third, the inhaled corticosteroids were supplemented with a long-acting anticholinergic drug (tiotropium bromide)
Anticholinergics block the nerves that tighten the muscles around the lungs' airways, whereas beta-agonists relax the muscles lining the breathing passages of the lungs.
Before the trial, the patients averaged 77 days per year when their asthma was under control and they didn't need to use their albuterol rescue inhalers. Doubling corticosteroids gave patients another 19 symptom-free days on average, while adding tiotropium to low-dose corticosteroids gave them another 48, similar to the improvement they had on corticosteroids plus salmeterol. But increasing corticosteroids and using beta-agonists both have risks.
"This is the first study to explore adding an anticholinergic inhaler to low-dose inhaled corticosteroids," said Dr. James Kiley, director of the NHLBI's division of lung diseases. "The Asthma Clinical Research Network is designed to address exactly these kinds of practical and important management questions, with the ultimate goal of helping asthma patients."
In addition to UW-Madison, other members of the Asthma Clinical Research Network who took part in this trial include:
- Brigham and Women's Hospital, Boston
- Columbia University, New York City
- Duke University, Durham, N.C.
- The University of Texas Medical Branch at Galveston
- National Jewish Medical and Research Center, Denver
- University of California, San Diego
- University of California, San Francisco
- Washington University School of Medicine, St. Louis
- Wake Forest University
The data coordinating center is at Penn State College of Medicine in Hershey, Pa.
Date Published: 09/22/2010