Tiotropium bromide step-up therapy for adults with uncontrolled asthma

Stephen P. Peters, Susan J. Kunselman, Nikolina Icitovic, Wendy C. Moore, Rodolfo Pascual, Bill T. Ameredes, Homer A. Boushey, William J. Calhoun, Mario Castro, Reuben M. Cherniack, Timothy Craig, Loren Denlinger, Linda L. Engle, Emily A. DiMango, John V. Fahy, Elliot Israel, Nizar Jarjour, Shamsah D. Kazani, Monica Kraft, Stephen C. LazarusRobert F. Lemanske, Njira Lugogo, Richard J. Martin, Deborah A. Meyers, Joe Ramsdell, Christine A. Sorkness, E. Rand Sutherland, Stanley J. Szefler, Stephen I. Wasserman, Michael J. Walter, Michael E. Wechsler, Vernon M. Chinchilli, Eugene R. Bleecker

Research output: Contribution to journalArticlepeer-review

491 Scopus citations


BACKGROUND: Long-acting beta-agonist (LABA) therapy improves symptoms in patients whose asthma is poorly controlled by an inhaled glucocorticoid alone. Alternative treatments for adults with uncontrolled asthma are needed. METHODS: In a three-way, double-blind, triple-dummy crossover trial involving 210 patients with asthma, we evaluated the addition of tiotropium bromide (a long-acting anticholinergic agent approved for the treatment of chronic obstructive pulmonary disease but not asthma) to an inhaled glucocorticoid, as compared with a doubling of the dose of the inhaled glucocorticoid (primary superiority comparison) or the addition of the LABA salmeterol (secondary noninferiority comparison). RESULTS: The use of tiotropium resulted in a superior primary outcome, as compared with a doubling of the dose of an inhaled glucocorticoid, as assessed by measuring the morning peak expiratory flow (PEF), with a mean difference of 25.8 liters per minute (P<0.001) and superiority in most secondary outcomes, including evening PEF, with a difference of 35.3 liters per minute (P<0.001); the proportion of asthmacontrol days, with a difference of 0.079 (P = 0.01); the forced expiratory volume in 1 second (FEV1) before bronchodilation, with a difference of 0.10 liters (P = 0.004); and daily symptom scores, with a difference of -0.11 points (P<0.001). The addition of tiotropium was also noninferior to the addition of salmeterol for all assessed outcomes and increased the prebronchodilator FEV1 more than did salmeterol, with a difference of 0.11 liters (P = 0.003). CONCLUSIONS: When added to an inhaled glucocorticoid, tiotropium improved symptoms and lung function in patients with inadequately controlled asthma. Its effects appeared to be equivalent to those with the addition of salmeterol. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov number, NCT00565266.).

Original languageEnglish (US)
Pages (from-to)1715-1726
Number of pages12
JournalNew England Journal of Medicine
Issue number18
StatePublished - Oct 28 2010
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine


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