Spiriva Plus a Steroid Inhaler Helps Manage Asthma
October 19, 2010
People with asthma who get only partial relief of asthma symptoms from steroid inhalers might have a new ally in their fight against the disease: Researchers have discovered that Spiriva (tiotropium bromide) can help to control asthma better than some other treatment options.
Most doctors have recommended that people with hard-to-manage asthma either double their steroid inhaler dosage, or add another drug like the long-acting beta agonist Serevent (salmeterol). But even doubling the dosage of steroids doesn't always result in effective asthma control, and Serevent is not well tolerated in all asthma patientsthere are concerns that long-acting beta agonist drugs may increase the risk of severe asthma symptoms in some people.
Spirivaused to treat chronic obstructive pulmonary disease, or COPDis an anticholinergic that relaxes smooth muscles in the lung in a different way than long-acting beta-agonists. To test its effectiveness, researchers from Wake Forest University gave 210 study participants with asthma either Spiriva plus a steroid inhaler, Serevent with a steroid inhaler, or a double dose of a steroid inhaler. All participants tried each therapy for a series of 14-week intervals, with a two-week "washout" interval between each treatment.
The results, published in The New England Journal of Medicine (NEJM), showed that Spiriva with a steroid inhaler worked better at improving the participants' morning peak expiratory flowa measure of lung function and breathing abilitywhen compared to a double dose of the steroid inhaler. The Spiriva combination was found to be just as effective as treatment with Serevent.
Spiriva, then, may become one more treatment option for people with inadequately controlled asthma, though the U.S. Food and Drug Administration (FDA) has not yet approved it for that use. The drug is dispensed in a capsule form that is activated in a Handihaler® inhalation device. Though it is generally well tolerated, an editorial that accompanied the NEJM article cautions that more research is needed to fully understand the risks and benefits of long-term use of Spiriva plus steroid inhalers to manage asthma. Whether Spiriva, for example, reduces asthma attacks to the same extent as long acting beta-agonists, such as Serevent, needs to be determined.
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Sources: Peters et al. "Tiotropium Bromide Step-Up Therapy for Adults with Uncontrolled Asthma." The New England Journal of Medicine, Sept. 19, 2010. DOI: 10.1056/NEJMoa1008770; and Smith. "Editorial: Anticholinergics for Patients with Asthma?" The New England Journal of Medicine, Sept. 19, 2010