388 Original Research [ 147#2 CHEST FEBRUARY 2015 ] What Is the Role of Tiotropium in Asthma? A Systematic Review With Meta-analysis Gustavo J. Rodrigo, MD; and José A. Castro-Rodríguez, MD, PhD BACKGROUND: he role of tiotropium for the treatment of asthma has not yet been clearly deined. he aim of this systematic review was to assess the eicacy and safety of tiotropium in patients with asthma. METHODS: Randomized placebo-controlled trials were included. Primary outcomes were peak and trough FEV 1 and morning and evening peak expiratory low (PEF). RESULTS: hirteen studies (4,966 patients) were included. hree diferent therapeutic proto- cols were identiied. Tiotropium as an add-on to inhaled corticosteroids (ICSs) showed statisti- cally and clinically significant increases in PEF (22-24 L/min) and FEV 1 (140-150 mL). Additionally, tiotropium decreased the rate of exacerbations (number needed to treat for ben- eit [NNTB], 36) and improved asthma control. he use of tiotropium in patients poorly con- trolled despite the use of medium to high doses of ICS was not inferior to salmeterol. Finally, the use of tiotropium as an add-on to ICS/salmeterol combination increased pulmonary function to a clinically signiicant magnitude, reduced asthma exacerbations (relative risk, 0.70; 95% CI, 0.53-0.94; P , .02; I 2 5 0%; NNTB, 17), and improved asthma control compared with ICS/ salmeterol. Tiotropium was well tolerated, and no potential safety signals were observed. CONCLUSIONS: Tiotropium resulted noninferiorly to salmeterol and superiorly to placebo in patients with moderate to severe asthma who were not adequately controlled by ICS or ICS/ salmeterol. Major beneits were concentrated in the increase in lung function and in the case of patients with severe asthma, in the reduction of exacerbations. CHEST 2015; 147(2):388-396 [ Original Research Asthma ] Manuscript received July 13, 2014; revision accepted September 23, 2014; originally published Online First October 16, 2014. ABBREVIATIONS: ACQ-7 5 Asthma Control Questionnaire 7; AE 5 adverse event; AQLQ 5 Asthma Quality of Life Questionnaire; ICS 5 inhaled corticosteroid; LABA 5 long-acting b 2 -agonist; MCID 5 minimal clinically important diference; NNTB 5 number needed to treat for beneit; OD 5 once daily; PEF 5 peak expiratory low; RCT 5 randomized controlled trial; SAE 5 serious adverse event AFFILIATIONS: From the Departamento de Emergencia (Dr Rodrigo), Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay; and Departments of Pediatrics and Family Medicine (Dr Castro-Rodríguez), School of Medicine, Pontiicia Universidad Católica de Chile, Santiago, Chile. FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study. CORRESPONDENCE TO: Gustavo J. Rodrigo, MD, Departamento de Emergencia, Hospital Central de las Fuerzas Armadas. Av. 8 de Octubre 3020, Montevideo 11300, Uruguay; e-mail: gustavo.javier.rodrigo@ gmail.com © 2015 AMERICAN COLLEGE OF CHEST PHYSICIANS. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details. DOI: 10.1378/chest.14-1698 Downloaded From: http://journal.publications.chestnet.org/ by a Universita Studi Di Torino User on 02/19/2015