COPD Drug Spiriva May Also Benefit Those with Asthma


Spiriva is a widely used drug for treating chronic obstructive pulmonary disease, or COPD. Researchers from Wake Forest University in North Carolina are also studying the drug, known generically as tiotropium bromide, for asthmatic patients who have difficulty obtaining relief with other asthma drugs. The results from the new study were presented at the European Respiratory Society meeting in Spain and published in the New England Journal of Medicine.

Sprivia, When Added to Low-Dose Steroids, Increases Symptom Free Days

Spiriva belongs to a class of medications called anticholinergics, which block a neurotransmitter called acetylcholine to relax and open airways – called bronchodilatation. Some physicians are already prescribing the medication for their asthmatic patients prior to FDA approval, a common practice known as off-label prescribing. Anticholinergics provide fairly fast relief of asthma symptoms, generally within one to two hours, and the effect lasts for 24 hours or more.

About 17 million Americans suffer from asthma, an inflammatory condition of the lungs characterized by coughing and breathing difficulties. Conventional treatments for asthma include low to moderate doses of inhaled steroids used to control swelling and inflammation, but in some this is not enough. In poorly controlled patients, physicians will then increase the steroid dose, which increases the risk of sore throat and pneumonia. Other bronchodilators, called beta-agonists may also be added, but these have side effects such as anxiety, tremor, palpitations, and low blood potassium.

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For the study, 210 adults were enrolled whose asthma was not well-controlled by steroids. Patients were each given one of three treatment options for 14 weeks, with two-week breaks in-between to “flush” drugs out of their systems. The treatments consisted of doubling low-dose steroids, continuation of low-dose steroids plus a beta-agonist (salmeterol, brand name Serevent), or continuation of low-dose steroids plus Spiriva.

Spiriva treatment increased the number of days in which patients had no asthma symptoms and did not need to use an albuterol rescue inhaler from 77 per year at the beginning of the study to 125 days. Treatment with the higher dose of steroid alone provided only 19 additional symptom-free days.

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Longer term trials with a larger pool of patients will be conducted to ensure that there are no unforeseen side effects for using Spiriva as an additional treatment option for asthma, says lead researcher Dr. Stephen P. Peters, a professor of pulmonary, critical care, allergy and immunologic medicine at Wake Forest University.

“My hope is that in three to five years we will have the drug approved for asthma,” he said.

Source reference:
Peters S, et al "Tiotropium bromide step-up therapy for adults with uncontrolled asthma" N Engl J Med 2010; DOI:10.1056/NEJMoa1008770