Cargando…

Long-acting muscarinic antagonist use in adults with asthma: real-life prescribing and outcomes of add-on therapy with tiotropium bromide

BACKGROUND: Randomized controlled trials indicate that addition of a long-acting muscarinic antagonist (LAMA) such as tiotropium may improve asthma control and reduce exacerbation risk in patients with poorly controlled asthma, but broader clinical studies are needed to investigate the effectiveness...

Descripción completa

Detalles Bibliográficos
Autores principales: Price, David, Kaplan, Alan, Jones, Rupert, Freeman, Daryl, Burden, Anne, Gould, Shuna, von Ziegenweidt, Julie, Ali, Muzammil, King, Christine, Thomas, Mike
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298307/
https://www.ncbi.nlm.nih.gov/pubmed/25609985
http://dx.doi.org/10.2147/JAA.S76639
_version_ 1782353250663530496
author Price, David
Kaplan, Alan
Jones, Rupert
Freeman, Daryl
Burden, Anne
Gould, Shuna
von Ziegenweidt, Julie
Ali, Muzammil
King, Christine
Thomas, Mike
author_facet Price, David
Kaplan, Alan
Jones, Rupert
Freeman, Daryl
Burden, Anne
Gould, Shuna
von Ziegenweidt, Julie
Ali, Muzammil
King, Christine
Thomas, Mike
author_sort Price, David
collection PubMed
description BACKGROUND: Randomized controlled trials indicate that addition of a long-acting muscarinic antagonist (LAMA) such as tiotropium may improve asthma control and reduce exacerbation risk in patients with poorly controlled asthma, but broader clinical studies are needed to investigate the effectiveness of LAMA in real-life asthma care. METHODS: Medical records of adults with asthma (aged ≥18 years) prescribed tiotropium were obtained from the UK Optimum Patient Care Research Database for the period 2001–2013. Patients diagnosed with chronic obstructive pulmonary disease were excluded, but no other clinical exclusions were applied. Two primary outcomes were compared in the year before (baseline) and the year after (outcome) addition of tiotropium: exacerbations (asthma-related hospital emergency department attendance or inpatient admission, or acute oral corticosteroid course) and acute respiratory events (exacerbation or antibiotic prescription with lower respiratory consultation). Secondary outcomes included lung function test results and short-acting β(2) agonist usage. The Wilcoxon signed-rank test was used for variables measured on the interval scale, the marginal homogeneity test for categorized variables, and the paired t-test for lung function indices. RESULTS: Of the 2,042 study patients, 83% were prescribed an inhaled corticosteroid and 68% a long-acting β(2) agonist during the baseline year; 67% were prescribed both. Comparing baseline and outcome years, the percentage of patients having at least one exacerbation decreased from 37% to 27% (P<0.001) and the percentage having at least one acute respiratory event decreased from 58% to 47% (P<0.001). There were no significant changes in lung function, and usage of short-acting β(2) agonists (in salbutamol/albuterol equivalents) increased from a median (interquartile range) of 274 (110, 548) to 329 (110, 603) μg/day (P=0.01). CONCLUSION: In this real-life asthma population, addition of LAMA therapy was associated with significant decreases in the incidence of exacerbations and antibiotic prescriptions for lower respiratory tract infections in the following year.
format Online
Article
Text
id pubmed-4298307
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher Dove Medical Press
record_format MEDLINE/PubMed
spelling pubmed-42983072015-01-21 Long-acting muscarinic antagonist use in adults with asthma: real-life prescribing and outcomes of add-on therapy with tiotropium bromide Price, David Kaplan, Alan Jones, Rupert Freeman, Daryl Burden, Anne Gould, Shuna von Ziegenweidt, Julie Ali, Muzammil King, Christine Thomas, Mike J Asthma Allergy Original Research BACKGROUND: Randomized controlled trials indicate that addition of a long-acting muscarinic antagonist (LAMA) such as tiotropium may improve asthma control and reduce exacerbation risk in patients with poorly controlled asthma, but broader clinical studies are needed to investigate the effectiveness of LAMA in real-life asthma care. METHODS: Medical records of adults with asthma (aged ≥18 years) prescribed tiotropium were obtained from the UK Optimum Patient Care Research Database for the period 2001–2013. Patients diagnosed with chronic obstructive pulmonary disease were excluded, but no other clinical exclusions were applied. Two primary outcomes were compared in the year before (baseline) and the year after (outcome) addition of tiotropium: exacerbations (asthma-related hospital emergency department attendance or inpatient admission, or acute oral corticosteroid course) and acute respiratory events (exacerbation or antibiotic prescription with lower respiratory consultation). Secondary outcomes included lung function test results and short-acting β(2) agonist usage. The Wilcoxon signed-rank test was used for variables measured on the interval scale, the marginal homogeneity test for categorized variables, and the paired t-test for lung function indices. RESULTS: Of the 2,042 study patients, 83% were prescribed an inhaled corticosteroid and 68% a long-acting β(2) agonist during the baseline year; 67% were prescribed both. Comparing baseline and outcome years, the percentage of patients having at least one exacerbation decreased from 37% to 27% (P<0.001) and the percentage having at least one acute respiratory event decreased from 58% to 47% (P<0.001). There were no significant changes in lung function, and usage of short-acting β(2) agonists (in salbutamol/albuterol equivalents) increased from a median (interquartile range) of 274 (110, 548) to 329 (110, 603) μg/day (P=0.01). CONCLUSION: In this real-life asthma population, addition of LAMA therapy was associated with significant decreases in the incidence of exacerbations and antibiotic prescriptions for lower respiratory tract infections in the following year. Dove Medical Press 2015-01-14 /pmc/articles/PMC4298307/ /pubmed/25609985 http://dx.doi.org/10.2147/JAA.S76639 Text en © 2015 Price et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Price, David
Kaplan, Alan
Jones, Rupert
Freeman, Daryl
Burden, Anne
Gould, Shuna
von Ziegenweidt, Julie
Ali, Muzammil
King, Christine
Thomas, Mike
Long-acting muscarinic antagonist use in adults with asthma: real-life prescribing and outcomes of add-on therapy with tiotropium bromide
title Long-acting muscarinic antagonist use in adults with asthma: real-life prescribing and outcomes of add-on therapy with tiotropium bromide
title_full Long-acting muscarinic antagonist use in adults with asthma: real-life prescribing and outcomes of add-on therapy with tiotropium bromide
title_fullStr Long-acting muscarinic antagonist use in adults with asthma: real-life prescribing and outcomes of add-on therapy with tiotropium bromide
title_full_unstemmed Long-acting muscarinic antagonist use in adults with asthma: real-life prescribing and outcomes of add-on therapy with tiotropium bromide
title_short Long-acting muscarinic antagonist use in adults with asthma: real-life prescribing and outcomes of add-on therapy with tiotropium bromide
title_sort long-acting muscarinic antagonist use in adults with asthma: real-life prescribing and outcomes of add-on therapy with tiotropium bromide
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298307/
https://www.ncbi.nlm.nih.gov/pubmed/25609985
http://dx.doi.org/10.2147/JAA.S76639
work_keys_str_mv AT pricedavid longactingmuscarinicantagonistuseinadultswithasthmareallifeprescribingandoutcomesofaddontherapywithtiotropiumbromide
AT kaplanalan longactingmuscarinicantagonistuseinadultswithasthmareallifeprescribingandoutcomesofaddontherapywithtiotropiumbromide
AT jonesrupert longactingmuscarinicantagonistuseinadultswithasthmareallifeprescribingandoutcomesofaddontherapywithtiotropiumbromide
AT freemandaryl longactingmuscarinicantagonistuseinadultswithasthmareallifeprescribingandoutcomesofaddontherapywithtiotropiumbromide
AT burdenanne longactingmuscarinicantagonistuseinadultswithasthmareallifeprescribingandoutcomesofaddontherapywithtiotropiumbromide
AT gouldshuna longactingmuscarinicantagonistuseinadultswithasthmareallifeprescribingandoutcomesofaddontherapywithtiotropiumbromide
AT vonziegenweidtjulie longactingmuscarinicantagonistuseinadultswithasthmareallifeprescribingandoutcomesofaddontherapywithtiotropiumbromide
AT alimuzammil longactingmuscarinicantagonistuseinadultswithasthmareallifeprescribingandoutcomesofaddontherapywithtiotropiumbromide
AT kingchristine longactingmuscarinicantagonistuseinadultswithasthmareallifeprescribingandoutcomesofaddontherapywithtiotropiumbromide
AT thomasmike longactingmuscarinicantagonistuseinadultswithasthmareallifeprescribingandoutcomesofaddontherapywithtiotropiumbromide