Effects of tiotropium on lung function in severe asthmatics with or without emphysematous changes |
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| Authors: | Makoto Yoshida Takako Nakano Satoru Fukuyama Takafumi Matsumoto Miyuki Eguchi Atsushi Moriwaki Shohei Takata Kentaro Machida Akiko Kanaya Koichiro Matsumoto Yoichi Nakanishi Hiromasa Inoue |
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| Institution: | 1. Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan;2. Division of Respiratory Medicine, National Fukuoka-Higashi Medical Center, 1-1-1 Chidori, Koga, Fukuoka 811-3195, Japan;3. Department of Hospital Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan;4. Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan;1. Department of Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, 410 N. 12th Street, P.O. Box 980533, Richmond, VA 23298-0533, USA;2. Department of Medicinal Chemistry and Institute for Structural Biology and Drug Discovery, Virginia Commonwealth University, 800 East Leigh Street, Richmond, VA 23219, USA;1. Department of Physiology, School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Beitou District, Taipei 112, Taiwan;2. Department of Neurosurgery, Cheng Hsin General Hospital, No. 45, Cheng Hsin Street, Beitou District, Taipei, Taiwan;1. Vascular Biology Center, Georgia Health Sciences University, 1459 Laney Walker Blvd, CB3210B, Augusta, GA 30912, USA;2. Department of Pediatrics, University of California, San Francisco, CA 94143, USA;3. The Cardiovascular Research Institute, University of California, San Francisco, CA 94143, USA;1. Department of Intensive and Critical Care Medicine, Flinders Medical Centre, Flinders University, Adelaide, Australia;2. Department of Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia;1. Department of Cardiothoracic Surgery, St Vincent''s Hospital, Melbourne, Australia;2. Department of Cardiac Surgery, Austin Hospital, Melbourne, Australia;3. Department of Surgery, Oregon Health and Science University, Portland, Ore |
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| Abstract: | The effects of tiotropium, an inhaled long-acting anti-cholinergic agent, on lung function were investigated in obstructed severe asthmatics with and without emphysematous changes despite maximal recommended treatments with high-dose of inhaled glucocorticoids and inhaled long-acting β2-agonists.We conducted a double-blind, placebo-controlled study of an inhaled single-dose of tiotropium in 18 asthmatics with emphysema and 18 without emphysema in a crossover manner. The primary efficacy outcome was the relative change in forced expiratory volume in 1 s (FEV1) from baseline to 60 min, and the secondary outcome was a relative change in FEV1 from baseline to 12 h. Subsequently, the patients were treated with tiotropium inhaled once daily for 12 weeks in an open label manner, and lung function and symptoms were evaluated.At baseline, patients with or without emphysema had a mean FEV1 of 55.9% before tiotropium and 56.8% before placebo, or 77.4% before tiotropium and 77.6% before placebo of the predicted value and were taking a mean dose of inhaled glucocorticoids of 1444 or 1422 μg/day. Among patients with emphysema, the increase from baseline FEV1 was 12.6 percentage points higher at 60 min after tiotropium than after placebo. Among patients without emphysema, the increase from baseline FEV1 was 5.4 percentage points higher at 60 min after tiotropium than after placebo.Tiotropium resulted in improved lung function and symptoms in asthmatics with and without emphysema. These findings suggest that tiotropium will provide a new strategy for the treatment of bronchial asthma and of overlapping asthma and COPD. |
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