TY  - JOUR
A1  - Zielen, Stefan
A1  - Reichert, Gianna
A1  - Donath, Helena
A1  - Trischler, Jordis
A1  - Schulze, Johannes B.
A1  - Eickmeier, Olaf
A1  - Eckrich, Jonas Martin
A1  - Blümchen, Katharina
T1  - Tiotropium as an add-on treatment option for severe uncontrolled asthma in preschool patients
T2  - Journal of asthma and allergy
N2  - Background: Toddlers with asthma suffer disproportionally more than school-aged children from exacerbations with emergency visits and hospital admissions despite inhaled corticosteroid (ICS) treatment. A recent trial for children ≤ 5 years showed tolerability of tiotropium and potential to reduce asthma-related events.
Methods: We conducted a retrospective analysis of electronic outpatient records (2017‒2019) of children < 6 years treated with ICS plus long-acting β2-agonists (LABAs) plus tiotropium as an add-on for uncontrolled severe asthma. The primary endpoint was a comparison of systemic corticosteroid (SCS) prescriptions 6 months before and after ICS/LABA/tiotropium start. Secondary endpoints included physician visits, hospitalisations and antibiotic prescriptions. We compared outcomes with children without asthma matched for age, sex, season and screening date.
Results: Compared with a mean 2.42 (95% CI: 1.75, 3.36) SCS courses per patient within 6 months prior to ICS/LABA/tiotropium, 0.74 (95% CI: 0.25, 1.08) SCS courses per patient were prescribed within 6 months after starting ICS/LABA/tiotropium (P< 0.001). Physician visits dropped from 9.23 (95% CI: 7.15, 12.72) to 5.76 (95% CI: 3.10, 7.70) per patient (P< 0.01). Nineteen hospitalisations were recorded 6 months before ICS/LABA/tiotropium compared with one hospitalisation after (P< 0.01). A mean 1.79 antibiotic courses (95% CI: 1.22, 2.23) per patient were prescribed before ICS/LABA/tiotropium compared with 0.74 (95% CI: 0.22, 1.00) after ICS/LABA/tiotropium (P< 0.001). Hospitalisation rates for patients at observation end were not statistically different from healthy controls before/after matching.
Interpretation: Our retrospective study showed that adding tiotropium to ICS/LABA is a new treatment option for patients with severe preschool asthma; however, larger confirmatory studies are needed.
KW  - preschool asthma
KW  - severe uncontrolled asthma
KW  - tiotropium
KW  - inhaled steroids
KW  - long-acting β2-agonists
KW  - LABAs
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/62938
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-629388
SN  - 1178-6965
VL  - 14
SP  - 23
EP  - 30
PB  - Dove Medical Press
CY  - Albany, Auckland
ER  -