Tiotropium Bromide as an Adjunct Therapy to Inhaled Corticosteroids in the Treatment of Adults With Chronic Asthma

Background: Asthma is a chronic respiratory disease effecting 24.6 million children and adults in the United States. Current treatment guidelines recommend the use of inhaled corticosteroids and both short and long acting beta agonists. Several systematic reviews have evaluated the use of anticholinergics with mixed results. Tiotropium bromide became available in the United States in 2004, yet there have been few studies utilizing this long acting anticholinergic for the treatment of asthma patients. Purpose: This paper evaluates the current literature on the improvements in pulmonary function in asthmatics with the use of tiotropium in addition to an ICS. GRADE was used to rate the quality of evidence. Method: An exhaustive search of the available literature using Medline, Pubmed, Web of Science, Cochrane Systematic Reviews and CINHAL. The keywords used included “tiotropium”, “asthma” and “adults” individually and in combination. Results: Four articles were found to be relevant to the topic of this paper. Two randomized clinical trials showed statistically improved lung function with the addition of tiotropium to an ICS. One observational study showed that 33% of patients demonstrated a response of ≥ 15% improvement in FEV1 with the addition of tiotropium. A case report also demonstrated improvements in PEF and a decrease in oral steroid use in a chronic asthma patient. Conclusion: Tiotropium bromide in conjunction with an ICS provides statistically significant improvement in lung function for adult patients with chronic asthma. This conclusion is based on a moderate grade of evidence using the GRADE analysis