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Evidence summaries

Tiotropium Added to Long-Acting Beta-Agonist and Inhaled Corticosteroid (Laba+ics) for Adults with Asthma

Tiotropium added to long-acting beta-agonist and inhaled corticosteroid (LABA+ICS) may reduce exacerbations compared to LABA+ICS only in adults with asthma with fewer adverse effects. Level of evidence: "C"

The quality of evidence is downgraded by imprecise results (wide confidence intervals and few outcome events).

Summary

A Cochrane review [Abstract] 1 included 3 studies with a total of 1 197 subjects with asthma taking combination long-acting beta-agonist and inhaled corticosteroid (LABA+ICS). People in the studies had a mean forced expiratory volume in one second (FEV1) of 55% of their predicted value, indicating severe asthma.People randomised to take tiotropium add-on seemed to have fewer exacerbations requiring oral corticosteroids and fewer exacerbations requiring hospital admission than those continuing to take LABA+ICS alone, but the confidence intervals did not rule out no difference over 48 weeks (table T1). Lung function tests (FEV1 and FVC) were slightly better with tiotropium. There was no difference in quality of life. People taking tiotropium add-on were less likely to experience non-serious or serious adverse events.

Tiotropium versus placebo in adults with asthma taking background LABA+ICS

OutcomeRelative effect(95% CI)Risk with placeboRisk with tiotropium (95% CI)Participants (studies)
Exacerbations requiring oral corticosteroidsOR 0.76(0.57 to 1.02)328 per 1000271 per 1000(218 to 333)907(2)
Exacerbations requiring hospital admissionOR 0.68(0.34 to 1.38)43 per 100030 per 1000 (15 to 59)1 191 (3)
Any adverse eventsOR 0.70(0.52 to 0.94)813 per 1000753 per 1000 (693 to 803)1 197 (3)
Serious adverse eventsOR 0.60(0.24 to 1.47)96 per 100060 per 1000 (25 to 134)1 197 (3)

Clinical comments

Note

Date of latest search: 8 January 2016

    References

    • Kew KM, Dahri K. Long-acting muscarinic antagonists (LAMA) added to combination long-acting beta2-agonists and inhaled corticosteroids (LABA/ICS) versus LABA/ICS for adults with asthma. Cochrane Database Syst Rev 2016;(1):CD011721. [PubMed]

Primary/Secondary Keywords