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Evid Based Med doi:10.1136/eb-2012-101100
  • Therapeutics
  • Randomised controlled trial

Tiotropium bromide triple combination therapy improves lung function and decreases asthma exacerbations

  1. Stephen P Peters
  1. Wake Forest School of Medicine, Center for Genomics, Medical Center Boulevard, Winston-Salem, North Carolina, USA
  1. Correspondence to: Professor Stephen P Peters
    Wake Forest School of Medicine, Center for Genomics, Medical Center Boulevard, Winston-Salem, NC 27157, USA; sppeters{at}wakehealth.edu

Commentary on: Kerstjens HA, Engel M, Dahl R, et al. Tiotropium in asthma poorly controlled with standard combination therapy. N Engl J Med 2012;367:1198–207.

Context

Three recent well-designed clinical trials demonstrated that tiotropium bromide, when added to an inhaled corticosteroid (ICS), provides asthma control which is non-inferior to adding a long-acting β-agonist (LABA).1–3 The third of these trials also suggested that adding tiotropium to an ICS–LABA combination also provides additional benefit, as measured by an improvement in lung function (FEV1).3 Whether adding tiotropium to patients inadequately controlled on combination ICS–LABA therapy would provide additional benefit by improving long-term asthma control and decreasing severe asthma exacerbations was the subject of the present article.

Methods

In two replicate trials of 912 …