Wake Forest School of Medicine, Winston-Salem, NC.
J Allergy Clin Immunol. 2013 Nov;132(5):1068-1074.e1. doi: 10.1016/j.jaci.2013.08.003. Epub 2013 Sep 29.
Tiotropium has activity as an asthma controller. However, predictors of a positive response to tiotropium have not been described.
We sought to describe individual and differential responses of asthmatic patients to salmeterol and tiotropium when added to an inhaled corticosteroid, as well as predictors of a positive clinical response.
Data from the double-blind, 3-way, crossover National Heart, Lung, and Blood Institute's Asthma Clinical Research Network's Tiotropium Bromide as an Alternative to Increased Inhaled Glucocorticoid in Patients Inadequately Controlled on a Lower Dose of Inhaled Corticosteroid (ClinicalTrials.gov number, NCT00565266) trial were analyzed for individual and differential treatment responses to salmeterol and tiotropium and predictors of a positive response to the end points FEV1, morning peak expiratory flow (PEF), and asthma control days (ACDs).
Although approximately equal numbers of patients showed a differential response to salmeterol and tiotropium in terms of morning PEF (n = 90 and 78, respectively) and ACDs (n = 49 and 53, respectively), more showed a differential response to tiotropium for FEV1 (n = 104) than salmeterol (n = 62). An acute response to a short-acting bronchodilator, especially albuterol, predicted a positive clinical response to tiotropium for FEV1 (odds ratio, 4.08; 95% CI, 2.00-8.31; P < .001) and morning PEF (odds ratio, 2.12; 95% CI, 1.12-4.01; P = 0.021), as did a decreased FEV1/forced vital capacity ratio (FEV1 response increased 0.39% of baseline for every 1% decrease in FEV1/forced vital capacity ratio). Higher cholinergic tone was also a predictor, whereas ethnicity, sex, atopy, IgE level, sputum eosinophil count, fraction of exhaled nitric oxide, asthma duration, and body mass index were not.
Although these results require confirmation, predictors of a positive clinical response to tiotropium include a positive response to albuterol and airway obstruction, factors that could help identify appropriate patients for this therapy.
噻托溴铵具有作为哮喘控制药物的活性。然而，尚未描述对噻托溴铵有阳性反应的预测因子。
我们旨在描述哮喘患者在吸入皮质类固醇的基础上加用沙美特罗和噻托溴铵时的个体和差异反应，以及预测对临床阳性反应的因素。
分析了双盲、3 向交叉、美国国立心肺血液研究所哮喘临床研究网络的噻托溴铵溴化物替代低剂量吸入皮质类固醇治疗哮喘患者（临床试验.gov 编号，NCT00565266）试验中沙美特罗和噻托溴铵的个体和差异治疗反应以及预测 FEV1、晨峰呼气流量（PEF）和哮喘控制天数（ACDs）终点阳性反应的因素。
尽管在晨 PEF（分别为 n = 90 和 78）和 ACD（分别为 n = 49 和 53）方面，大约相同数量的患者对沙美特罗和噻托溴铵表现出差异反应，但更多患者对 FEV1（n = 104）表现出对噻托溴铵的差异反应比沙美特罗（n = 62）更多。急性短效支气管扩张剂反应，尤其是沙丁胺醇，预测噻托溴铵对 FEV1（优势比，4.08；95%置信区间，2.00-8.31；P <.001）和晨 PEF（优势比，2.12；95%置信区间，1.12-4.01；P = 0.021）的阳性临床反应，FEV1/用力肺活量比（FEV1 反应增加 0.39%，基线 FEV1/用力肺活量比每下降 1%）也有预测作用。较高的胆碱能张力也是一个预测因素，而种族、性别、特应性、IgE 水平、痰嗜酸性粒细胞计数、呼气一氧化氮分数、哮喘持续时间和体重指数则不是。
尽管这些结果需要进一步证实，但噻托溴铵阳性临床反应的预测因素包括对沙丁胺醇的阳性反应和气道阻塞，这些因素可以帮助识别适合这种治疗的患者。
