scholarly journals Tiotropium bromide as adjunct therapy in children with asthma: a clinical experience

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Zainab Ridha ◽  
Marc-Antoine Bédard ◽  
Anna Smyrnova ◽  
Olivier Drouin ◽  
Aniela Pruteanu ◽  
...  
Keyword(s):  
Lung Function ◽  
Adverse Effects ◽  
Asthma Control ◽  
Severe Asthma ◽  
Clinical Experience ◽  
Tiotropium Bromide ◽  
Treatment Goals ◽  
Improve Lung Function ◽  
Adjunct Therapy ◽  
Children With Asthma

Abstract Background The Global Initiative for Asthma has only recently added tiotropium bromide as adjunct controller therapy in severe asthma (Step 4 or 5) in adults (2015) and children (2019). Although not yet approved for pediatric use by Health Canada, it has been occasionally offered by asthma specialists as a therapeutic trial in children with troublesome asthma or treatment for adverse effects. The objective of this study was to describe the indications and real-life clinical experience in initiating tiotropium in children with asthma. Methods We designed a retrospective mixed-method case series study of children aged 1–17 years who initiated tiotropium in our tertiary-care centre between 2013 and 2020. Clinical information was extracted from electronic medical records and tiotropium dispensing, from drug claims. Parents/children and physicians independently completed a questionnaire about treatment goals, perceived efficacy, safety, satisfaction, and lessons learned. Results The 34 (11 females; 23 males) children had a median (range) age of 9.1 (1.4–17.8) years. Children were primarily on Step 4 (85%) or 5 (6%) prior to tiotropium initiation, yet most (84%) did not increase their treatment step after tiotropium initiation. The physicians’ treatment goals were to improve asthma control, alleviate adverse effects of current therapy, and/or improve lung function. The most improved symptoms were coughing/moist cough, difficulty breathing, whistling breath, and bronchial secretions/mucus. Although most parents and physicians reported a significant benefit with tiotropium bromide, physicians particularly remarked, as their “lesson learned’, on the improvement in chronic symptoms in asthmatic children, particularly those with prominent moist cough and in lung function, in those with seemingly none (or incompletely) reversible obstruction as well as the ability to decrease the ICS and/or LABA dose to lessen adverse effects. A few physicians raised caution on the risk of lower adherence with an additional inhaler. Conclusion In children with severe asthma on Step 4 or 5, tiotropium bromide was primarily used as substitute, rather than additional, adjunct therapy to improve asthma control, alleviate adverse effects, and/or to improve lung function. The latter two indications, combined with its perceived effectiveness in children with prominent moist cough, also suggest additional indications of tiotropium to be formally explored.

scholarly journals Tiotropium Bromide As Adjunct Therapy In Children With Asthma: A Clinical Experience

2021 ◽  
Author(s):  
Zainab Ridha ◽  
Marc-Antoine Bédard ◽  
Anna Smyrnova ◽  
Olivier Drouin ◽  
Aniela Pruteanu ◽  
...  
Keyword(s):  
Lung Function ◽  
Adverse Effects ◽  
Asthma Control ◽  
Severe Asthma ◽  
Clinical Experience ◽  
Tiotropium Bromide ◽  
Treatment Goals ◽  
Improve Lung Function ◽  
Adjunct Therapy ◽  
Children With Asthma

Abstract Background: The Global Initiative for Asthma has only recently been added tiotropium bromide as adjunct controller therapy in severe asthma (Step 4 or 5) in adults (2015) and children (2019). Although not yet approved for pediatric use by Health Canada, it has been occasionally offered by asthma specialists as a therapeutic trial in children with troublesome asthma or treatment adverse effects. The objective of this study was to describe the indications and real-life clinical experience in initiating tiotropium in children with asthma.Methods: We designed a retrospective mixed-method case series study of children aged 1-17 years who initiated tiotropium in our tertiary-care centre between 2013-2020. Clinical information was extracted from electronic medical records and tiotropium dispensing, from drug claims. Parents/children and physicians independently completed a questionnaire about treatment goals, perceived efficacy, safety, satisfaction, and lessons learned. Results: The 34 (11 females; 23 males) children had a median (range) age of 9.1 (1.4-17.8) years. Children were primarily on Step 4 (85%) or 5 (6%) prior to, yet most (84%) did not increase their treatment step after, tiotropium initiation. The physicians’ treatment goals were to improve asthma control, alleviate adverse effects of current therapy, and/or improve lung function. The most improved symptoms were coughing/moist cough, difficulty breathing, whistling breath, and bronchial secretions/mucus. Although most parents and physicans reported a significant benefit with tiotropium bromide, physicians particularly remarked, as their “lesson learned’, on the improvement in chronic symptoms in asthmatic children, particularly those with prominent moist cough and in lung function, in those with apparent fixed obstruction as well as the ability to decrease the ICS and/or LABA dose to lessen adverse effects. A few physicians raised caution on the risk of lower adherence with an additional inhaler. Conclusion: In children with severe asthma on Step 4 or 5, tiotropium bromide was primarily used as substitute, rather than additional, adjunct therapy to improve asthma control, alleviate adverse effects and/or to improve lung function. The latter two indications, combined with its perceived effectiveness in children with prominent moist cough, also suggest additional indications of tiotropium to be formally explored.

scholarly journals New possibilities for asthma therapy in children

2018 ◽  
pp. 192-198 ◽  
Author(s):  
T. N. Surovenko ◽  
Е. F. Glushkova
Keyword(s):  
Lung Function ◽  
Asthma Control ◽  
Russian Federation ◽  
Asthma Severity ◽  
Asthma Therapy ◽  
Improve Lung Function ◽  
The Russian Federation ◽  
Asthma In Children ◽  
Long Acting ◽  
Step Therapy

This article discusses issues of clinical diagnosis and course of bronchial asthma in children. We discuss assessment of asthma severity and, accordingly, the extent of the step-by-step therapy according to updated recommendations (GINA 2018). Particular attention is paid to the possibility of improving the control of asthma with the help of the M-cholinolytic drug of long-acting tiotropium bromide, presented as a special inhalation form of tiotropium Respimat and registered in the Russian Federation for treatment of asthma in children of moderate and severe course from 6 years of age. Application tiotropium Respimat in children with insufficient control of asthma allows to improve lung function and asthma control.

scholarly journals Patient and Physician Perspectives on Asthma and Its Therapy in Romania: Results of a Multicenter Survey

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1089
Author(s):  
Dragos Bumbacea ◽  
Carmen Panaitescu ◽  
Roxana Silvia Bumbacea
Keyword(s):  
Maintenance Therapy ◽  
Asthma Control ◽  
Severe Asthma ◽  
Asthma Management ◽  
Asthma Severity ◽  
Treatment Goals ◽  
Cross Sectional ◽  
Multicenter Survey ◽  
Patient Reported ◽  
Asthma Patients

Background and Objectives: Patient’s behaviours, attitudes and beliefs related to asthma and its treatment were shown to influence the adherence to therapy and the level of asthma control. This survey aimed to assess the level of asthma control and patient-reported behaviours, attitudes and expectations related to their disease in Romanian patients. Materials and Methods: This cross-sectional quantitative survey was performed in February-March 2019 and enrolled 70 specialist physicians experienced in asthma management and 433 asthma patients under their care. Results: Of the 433 patients enrolled, 19.4% had mild asthma, 60.5% moderate asthma and 20.1% severe asthma. For the previous 12 months, asthma symptoms, exacerbations and emergency room visits were common in the sample analysed, with significantly higher figures in severe asthma patients (p < 0.001). The most important treatment goal for asthma patients was participation in all activities of daily living, while for physicians this was preventing asthma exacerbations. The valuation of the treatment goals was different between patients with severe asthma and those with mild and moderate forms. Based on the patients’ responses, 3 attitude clusters were identified: empowered savvy (36.5% of the patients), pessimistic non-compliers (43.2%), and anxious strugglers (20.3%). “Empowered savvy” had the lowest frequency of severe asthma, the highest adherence to maintenance therapy and the highest level of confidence in the effectiveness of asthma medication. The opposite of this attitude cluster is the “anxious strugglers”, containing more patients with severe asthma, a higher score for worries about asthma therapy and better self-reported knowledge of their treatment, contrasting with a proportion of 25% taking maintenance therapy only when having breathing difficulties. Conclusion: Asthma control in Romania remains poor, with frequent exacerbations and hospitalizations. The differences in treatment goals found between patients and physicians and between different asthma severity groups suggest the need for more patient-centred approaches.

scholarly journals Assessment of asthma control and lung function in asthmatic children in Sokoto, North Western Nigeria

2021 ◽  
Vol 0 ◽  
pp. 1-6
Author(s):  
Fatima Abubakar Ishaq ◽  
Bilkisu Ilah Garba ◽  
Nma Mohammad Jiya ◽  
Ahmed Hamidu
Keyword(s):  
Lung Function ◽  
Asthma Control ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Cross Sectional ◽  
Asthmatic Children ◽  
Children With Asthma ◽  
Global Initiative ◽  
Gina Guidelines ◽  
Study Participants

Objectives: This study aimed at assessing asthma control using Global Initiative for Asthma (GINA) asthma assessment, and determining its relationship with lung function parameters among asthmatic children in Usmanu Danfodiyo University Teaching hospital, Sokoto. Materials and Methods: This was a cross-sectional study among 60 children with asthma diagnosed based on GINA guidelines. It was conducted over a period of 4 months. The GINA asthma control assessment was administered to assess asthma control. Lung function was done using a portable spirometer. Results: Males accounted for 58.3% of the study population with M: F of 1.4:1 and median age of 9.47 years, with majority from urban domicile (91.7%). Well-controlled asthma accounted for 50.0% while 35.0% had partly controlled asthma and 15.0% had poorly controlled asthma. The median FEV1/FVC among the study participants was 0.856 (IQR: 0.170). There was no relationship between asthma control and LF parameters (FEV1: r = 0.044, P = 0.736, FVC: r = 0.010, P = 0.941, FEV1/FVC: r = 0.122, P = 0.352, and PEFR: r = 0.015, P = 0.911). Conclusion: Majority of the study participants had well-controlled asthma and no relationship was found between asthma control and lung function. Thus, serial monitoring of LF in addition to uniformly agreed standardized assessment of asthma control is required to objectively evaluate asthma control in children.

scholarly journals Vitamin D supplementation, lung function, and asthma control in children with asthma and low vitamin D levels

2021 ◽  
pp. 2100989
Author(s):  
Yueh-Ying Han ◽  
Erick Forno ◽  
Leonard B. Bacharier ◽  
Wanda Phipatanakul ◽  
Theresa W. Guilbert ◽  
...  
Keyword(s):  
Vitamin D ◽  
Lung Function ◽  
Asthma Control ◽  
Vitamin D Supplementation ◽  
Vitamin D Levels ◽  
Children With Asthma
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