Abadoglu Oznur, Berk Serdar
Department of Chest Diseases, Subdepartment of Immunology and Allergy Diseases, Faculty of Medicine, Cumhuriyet Üniversity, Sivas, Turkey.
Department of Chest Diseases, Faculty of Medicine, Cumhuriyet Üniversity, Sivas, Turkey.
Clin Respir J. 2016 Jul;10(4):421-7. doi: 10.1111/crj.12230. Epub 2014 Nov 9.
Some patients with asthma have poorly controlled disease despite the use of high-dose inhaled corticosteroids (ICS), long-acting β2 agonists (LABAs) and antileukotrienes. The aim of the study was to assess the effectiveness of tiotropium as an add-on therapy to the standard treatment with high-dose ICS/LABA on asthma control and lung function in patients with severe asthma.
Of the 633 asthmatic patients, 64 (10.1%) patients with severe asthma who were add-on treated at least for 3 months were evaluated. Number of exacerbations, emergency department visits, hospitalizations and lung functions of patients belonging to 12 months before starting add-on treatment were compared with those of 12 months after starting add-on treatment.
The mean duration of add-on tiotropium treatment was 8.3 ± 0.5 months. For patients with severe asthma that was poorly controlled with standard combination therapy, tiotropium improved asthma control in 42.2%, decreased the number of emergency department visits in 46.9% and decreased the number of hospitalizations in 50.0% of them. The mean baseline forced expiratory volume in 1 s before add-on tiotropium was 57.5 ± 1.9% and forced vital capacity was 74.3 ± 15.6%. However, after 12 months of add-on tiotropium treatment, these rates became 65.5 ± 1.9% and 82.5 ± 15.1%, respectively. The addition of tiotropium significantly improved the percentages of the number of emergency department visits, the number of hospitalizations (P < 0.05).
Our study has suggested that, for patients with poorly controlled asthma despite of the use of ICS/LABA, the addition of tiotropium to standard care may be beneficial.
尽管使用了高剂量吸入性糖皮质激素（ICS）、长效β2受体激动剂（LABA）和抗白三烯药物，但仍有一些哮喘患者的病情控制不佳。本研究的目的是评估噻托溴铵作为高剂量ICS/LABA标准治疗的附加疗法对重度哮喘患者哮喘控制和肺功能的有效性。
在633例哮喘患者中，对64例（10.1%）接受附加治疗至少3个月的重度哮喘患者进行了评估。将开始附加治疗前12个月患者的加重次数、急诊就诊次数、住院次数和肺功能与开始附加治疗后12个月的情况进行比较。
附加噻托溴铵治疗的平均持续时间为8.3±0.5个月。对于标准联合治疗控制不佳的重度哮喘患者，噻托溴铵使42.2%的患者哮喘得到改善，46.9%的患者急诊就诊次数减少，50.0%的患者住院次数减少。附加噻托溴铵治疗前1秒用力呼气容积的平均基线值为57.5±1.9%，用力肺活量为74.3±15.6%。然而，附加噻托溴铵治疗12个月后，这些比率分别变为65.5±1.9%和82.5±15.1%。添加噻托溴铵显著改善了急诊就诊次数、住院次数的百分比（P<0.05）。
我们的研究表明，对于尽管使用了ICS/LABA但哮喘控制不佳的患者，在标准治疗中添加噻托溴铵可能有益。
