TY - JOUR T1 - Tiotropium versus placebo for inadequately controlled asthma: a meta-analysis JF - Respiratory Care DO - 10.4187/respcare.02703 SP - respcare.02703 AU - Jing-wei Tian AU - Jin-wu Chen AU - Rui Chen AU - Xin Chen Y1 - 2013/10/29 UR - http://rc.rcjournal.com/content/early/2013/10/29/respcare.02703.abstract N2 - 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. ER -