부산대학교 도서관

Background: Randomized controlled trials indicate that addition of a long-acting muscarinic antagonist (LAMA) such as tiotropium may improve asthma control and reduce exacerbation risk in patients with poorly controlled asthma, but broader clinical studies are needed to investigate the effectiveness of LAMA in real-life asthma care. Methods: Medical records of adults with asthma (aged [greater than or equal to] 18 years) prescribed tiotropium were obtained from the UK Optimum Patient Care Research Database for the period 2001-2013. Patients diagnosed with chronic obstructive pulmonary disease were excluded, but no other clinical exclusions were applied. Two primary outcomes were compared in the year before (baseline) and the year after (outcome) addition of tiotropium: exacerbations (asthma-related hospital emergency department attendance or inpatient admission, or acute oral corticosteroid course) and acute respiratory events (exacerbation or antibiotic prescription with lower respiratory consultation). Secondary outcomes included lung function test results and short-acting [β.sub.2] agonist usage. The Wilcoxon signed-rank test was used for variables measured on the interval scale, the marginal homogeneity test for categorized variables, and the paired t-test for lung function indices. Results: Of the 2,042 study patients, 83% were prescribed an inhaled corticosteroid and 68% a long-acting [β.sub.2] agonist during the baseline year; 67% were prescribed both. Comparing baseline and outcome years, the percentage of patients having at least one exacerbation decreased from 37% to 27% (P Conclusion: In this real-life asthma population, addition of LAMA therapy was associated with significant decreases in the incidence of exacerbations and antibiotic prescriptions for lower respiratory tract infections in the following year. Keywords: anticholinergic, bronchodilator, exacerbation, asthma control, oral corticosteroids
Introduction Tiotropium bromide is an anticholinergic drug, categorized as a long-acting muscarinic antagonist (LAMA) or long-acting anticholinergic bronchodilator. (1) These drugs are used primarily in the management of chronic obstructive [...]