Tiotropium bromide as adjunct therapy in children with asthma: a clinical experience

Allergy, Asthma & Clinical Immunology

Anna Smyrnova¹  Olivier Drouin²  Francine M. Ducharme²  Marc-Antoine Bédard³  Sandrine Essouri⁴  Aniela Pruteanu⁴  Zainab Ridha⁵ 

[1] Clinical Research and Knowledge Transfer Unit On Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada;Clinical Research and Knowledge Transfer Unit On Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada;Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada;Department of Pediatrics, Faculty of Medicine, Université de Montréal, Sainte-Justine Hospital, Montreal, QC, Canada;Department of Social and Preventive Medicine, Public Health School, University of Montreal, Montreal, QC, Canada;Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada;Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada;Department of Pediatrics, Faculty of Medicine, Université de Montréal, Sainte-Justine Hospital, Montreal, QC, Canada;Faculty of Medicine, Université Laval, 1050, Avenue de la Médecine, G1V 0A6, Quebec, QC, Canada;Clinical Research and Knowledge Transfer Unit On Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada;

关键词: Asthma;    Children;    Tiotropium bromide;    Therapeutic trial;    Pediatric care;    Case series;   

DOI  :  10.1186/s13223-021-00632-4

来源: Springer

【 摘 要 】

BackgroundThe Global Initiative for Asthma has only recently added tiotropium bromide as adjunct controller therapy in severe asthma (Step 4 or 5) in adults (2015) and children (2019). Although not yet approved for pediatric use by Health Canada, it has been occasionally offered by asthma specialists as a therapeutic trial in children with troublesome asthma or treatment for adverse effects. The objective of this study was to describe the indications and real-life clinical experience in initiating tiotropium in children with asthma.MethodsWe designed a retrospective mixed-method case series study of children aged 1–17 years who initiated tiotropium in our tertiary-care centre between 2013 and 2020. Clinical information was extracted from electronic medical records and tiotropium dispensing, from drug claims. Parents/children and physicians independently completed a questionnaire about treatment goals, perceived efficacy, safety, satisfaction, and lessons learned.ResultsThe 34 (11 females; 23 males) children had a median (range) age of 9.1 (1.4–17.8) years. Children were primarily on Step 4 (85%) or 5 (6%) prior to tiotropium initiation, yet most (84%) did not increase their treatment step after tiotropium initiation. The physicians’ treatment goals were to improve asthma control, alleviate adverse effects of current therapy, and/or improve lung function. The most improved symptoms were coughing/moist cough, difficulty breathing, whistling breath, and bronchial secretions/mucus. Although most parents and physicians reported a significant benefit with tiotropium bromide, physicians particularly remarked, as their “lesson learned’, on the improvement in chronic symptoms in asthmatic children, particularly those with prominent moist cough and in lung function, in those with seemingly none (or incompletely) reversible obstruction as well as the ability to decrease the ICS and/or LABA dose to lessen adverse effects. A few physicians raised caution on the risk of lower adherence with an additional inhaler.ConclusionIn children with severe asthma on Step 4 or 5, tiotropium bromide was primarily used as substitute, rather than additional, adjunct therapy to improve asthma control, alleviate adverse effects, and/or to improve lung function. The latter two indications, combined with its perceived effectiveness in children with prominent moist cough, also suggest additional indications of tiotropium to be formally explored.

【 授权许可】

CC BY