Abstract
Objective This meta-analysis was performed to evaluate the efficacy and safety of addition of tiotropium to standard treatment regimens for inadequately controlled asthma.
Methods A systematic search was made of Pubmed, EMBASE, Medline, CENTRAL databases and Clinicaltrials.gov, and a hand search of leading respiratory journals. Randomized, double-blinding clinical trials on treatment of inadequately controlled asthma for 4 or more weeks with the addition of tiotropium, compared with placebo, were reviewed. Studies were pooled to odds ratio (OR) and weighted mean differences (WMD), with 95% confidence interval (CI).
Results Six trials met the inclusion criteria. Addition of tiotropium, compared with placebo, significantly improved all spirometric indices, including morning and evening PEF (WMD 20.59 L/min, 95% CI 15.36 to 25.81 L/min, P<.001 and WMD 24.95 L/min, 95% CI 19.22 to 30.69 L/min, P<.001, respectively), trough and peak FEV1 (WMD 0.13 L, 95% CI 0.09 to 0.18 L, P<.001 and WMD 0.10 L, 95% CI 0.06 to 0.14 L, P<.001 respectively), FEV1AUC0-3h (WMD 0.13 L, 95% CI 0.08 to 0.18 L, P<.001), trough and peak FVC (WMD 0.1 L, 95% CI 0.05 to 0.15 L, P<.001 and WMD 0.08 L, 95% CI 0.04 to 0.13 L, P<.001 respectively), FVCAUC0-3h(WMD 0.11 L, 95% CI 0.06 to 0.15 L, P<.001). The mean change in ACQ-7 (WMD -0.12, 95% CI -0.21 to -0.03, P=.01) was markedly lower in tiotropium group, but not clinically significant. There were no significant differences in AQLQ score (WMD 0.09, 95% CI -0.01 to 0.20, P=.09), night awakenings (WMD 0.00, 95% CI -0.05 to 0.05, P=.99) or rescue medication use (WMD -0.18, 95% CI -0.36 to 0.00, P=.06). No significant increase was noticed in adverse events in tiotropium group (OR 0.80, 95% CI 0.62 to 1.03, p=.08).
Conclusion Addition of tiotropium to standard treatment regimens has significantly improved lung function without increasing adverse events in patients with inadequately controlled asthma. Long-term trials are required to assess the effects of addition of tiotropium on asthma exacerbations and mortality.
Footnotes
- ↵*,Corresponding author:
Department of Respiratory diseases, SUN Yat-sen memorial hospital affiliated to SUN Yat-sen University, #107 Yan Jiang Rd., Guangzhou 510120, China. Email: gzchenrui{at}163.com. Tel:86-18033202098
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