Rashid Qura, Klein Robin
From the Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia.
South Med J. 2014 May;107(5):330-7. doi: 10.1097/SMJ.0000000000000108.
Asthma is a chronic disease with a significant disease burden, and many patients fail to achieve disease control despite recommended medical therapy. Recent evidence suggests that there may be benefits to the use of the long-acting anticholinergic agent tiotropium in patients with asthma.
We performed a systematic review of the literature to determine the role of tiotropium in management of adult patients with asthma.
In six studies, 1773 patients were randomized and 1057 received tiotropium as an intervention. The mean prebronchodilator forced expiratory volume in 1 second was 60.1%. All six studies reported a small but statistically significant improvement in spirometry when using tiotropium as compared with the control. Improvement was reported in patients with both moderate and severe asthma, patients uncontrolled on previous regimens, patients treated with low- to high-dose inhaled corticosteroids regimens, and patients treated with and without long-acting β-agonist therapy. Five studies evaluated clinical outcomes with tiotropium with variable success rates. Although a large randomized trial demonstrated a reduction in the frequency of severe asthma exacerbation with tiotropium, there is insufficient evidence to support the argument that tiotropium therapy leads to improvements in asthma symptom measures, asthma control days, asthma-related quality-of-life-scores, or rescue inhaler use.
There is strong evidence supporting improvement in spirometry and asthma exacerbations with tiotropium in patients with moderate and severe asthma; therefore, tiotropium may be an effective intervention in patients with asthma.
哮喘是一种具有重大疾病负担的慢性疾病，尽管采用了推荐的药物治疗，许多患者仍未能实现疾病控制。最近的证据表明，长效抗胆碱能药物噻托溴铵用于哮喘患者可能有益。
我们对文献进行了系统评价，以确定噻托溴铵在成年哮喘患者管理中的作用。
在六项研究中，1773例患者被随机分组，1057例接受噻托溴铵作为干预措施。支气管扩张剂使用前1秒用力呼气容积平均为60.1%。所有六项研究均报告，与对照组相比，使用噻托溴铵时肺功能测定有小幅但具有统计学意义的改善。中度和重度哮喘患者、既往治疗方案未得到控制的患者、接受低至高剂量吸入性糖皮质激素方案治疗的患者以及接受和未接受长效β受体激动剂治疗的患者均有改善报告。五项研究评估了噻托溴铵的临床结局，成功率各不相同。尽管一项大型随机试验表明噻托溴铵可降低严重哮喘发作的频率，但没有足够的证据支持噻托溴铵治疗可改善哮喘症状指标、哮喘控制天数、哮喘相关生活质量评分或急救吸入器使用情况这一观点。
有强有力的证据支持噻托溴铵可改善中度和重度哮喘患者的肺功能测定结果及哮喘发作情况；因此，噻托溴铵可能是哮喘患者的一种有效干预措施。
