The role of Tiotropium ( Spiriva ) for the treatment of adolescents with asthma has not yet been clearly defined. A study has assessed the efficacy and safety of inhaled Tiotropium in adolescents with moderate to severe symptomatic asthma.
Randomized, placebo-controlled trials were included in this systematic review. Primary outcomes were peak and trough forced expiratory volume in 1 second ( FEV1 ).
Three studies ( approximately 1,000 patients ) were included. Tiotropium was associated with significant improvements in FEV1 peak ( mean change from baseline ) by 120 mL ( P less than 0.001 ) and trough by 100 mL ( P less than 0.001 ) compared with placebo.
Tiotropium has significantly reduced the percentage of patients who experienced an Asthma Control Questionnaire 7 worsening episode defined as a change from trial baseline of 0.5 points or more compared with placebo ( 2.1% vs 4.8%, number needed to treat, NNT= 38 ) and also was associated with a significantly decreased in the number of patients with at least one exacerbation compared with placebo ( 17.6 vs 23.8%, NNT=16 ).
Finally, no significant differences were found in rescue medication use, withdrawals, withdrawals due to adverse events, adverse events ( 27.3% vs 27.1% ), and serious adverse reactions ( 6.5% vs 7.1% ). Tiotropium in doses of 2.5 mcg once daily or 5.0 mcg once daily resulted in equivalent effects.
In conclusion, Tiotropium was well tolerated and efficacious as an addition to maintenance treatment with an inhaled corticosteroid or an inhaled corticosteroid plus a long-acting beta-agonist in adolescents with moderate to severe asthma.
Available data do not suggest an advantage of the 5-mcg once-daily dose ( used in adults ) compared with the 2.5-mcg once-daily dose of Tiotropium. ( Xagena )
Rodrigo GJ, Castro-Rodríguez JA, Ann Allergy Asthma Immunol 2015;115:211-216