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Mosnaim G, Bizik BK, Wilson C, Bensch G. Efficacy and safety of add-on tiotropium in the management of uncontrolled asthma: a patient case series. J Asthma 2021; 59:1231-1236. [PMID: 33974467 DOI: 10.1080/02770903.2021.1914648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Despite the availability of various treatment options, a large proportion of patients with asthma have uncontrolled asthma in the United States. Consequently, the economic burden of suboptimal asthma control is anticipated to substantially grow in the next 20 years, adversely impacting patients' quality of life. Therefore, there is an urgent need for effective treatments to achieve and maintain asthma control. The Global Initiative for Asthma recommends tiotropium as a controller medication for patients with asthma aged ≥6 years, based on evidence from several randomized controlled trials. However, more real-world data on the effectiveness of tiotropium are required to establish a broad picture of its use in everyday clinical practice. METHODS Herein, we present 3 case reports of patients diagnosed with uncontrolled or fixed obstructive asthma not responding to inhaled corticosteroids (ICS) or ICS + long-acting β2-agonists (LABAs) and/or leukotriene receptor antagonists (LTRAs). RESULTS All 3 patients were prescribed tiotropium, irrespective of their age. Tiotropium improved lung function and quality of life, as indicated by the forced expiratory volume in 1 s/forced vital capacity ratio and the Asthma Control Test score. Furthermore, the addition of tiotropium reduced the use of rescue medication. CONCLUSIONS Hence, the results from these case reports highlight that tiotropium could be an effective and safe add-on treatment option for patients across a range of age groups with uncontrolled or fixed obstructive asthma receiving prior ICS or ICS + LABA and/or LTRA therapy.
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Affiliation(s)
- Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University HealthSystem, IL, USA
| | | | - Christy Wilson
- Piedmont Healthcare Department of Pulmonary, Critical Care and Sleep Medicine, GA, USA
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Lee NR, Gujarathi S, Bommagani S, Siripurapu K, Zheng G, Dwoskin LP. Muscarinic agonist, (±)-quinuclidin-3-yl-(4-fluorophenethyl)(phenyl)carbamate: High affinity, but low subtype selectivity for human M 1 - M 5 muscarinic acetylcholine receptors. Bioorg Med Chem Lett 2019; 29:471-476. [PMID: 30554957 PMCID: PMC7160324 DOI: 10.1016/j.bmcl.2018.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 11/21/2018] [Accepted: 12/10/2018] [Indexed: 11/21/2022]
Abstract
Novel quinuclidinyl N-phenylcarbamate analogs were synthesized, and binding affinities at M1-M5 muscarinic acetylcholine receptor (mAChR) subtypes were determined using Chinese hamster ovary (CHO) cell membranes stably expressing one specific subtype of human mAChR. Although not subtype selective, the lead analog (±)-quinuclidin-3-yl-(4-fluorophenethyl)(phenyl)carbamate (3c) exhibited the highest affinity (Ki = 2.0, 13, 2.6, 2.2, 1.8 nM) at each of the M1-M5 mAChRs, respectively. Based on results from the [3H]dopamine release assay using rat striatal slices, 3c acted as an agonist at mAChRs. The effect of 3c was inhibited by the nonselective mAChR antagonist, scopolamine, and 3c augmented release evoked by oxotremorine. A potent analog from the same scaffold, (±)-quinuclidin-3-yl-(4-methoxyphenethyl)(phenyl)-carbamate (3b) exhibited the greatest selectivity (17-fold) at M3 over M2 mAChRs. These analogs could serve as leads for further discovery of novel subtype-selective muscarinic ligands with the goal of providing therapeutics for substance use disorders and chronic obstructive pulmonary disease.
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Affiliation(s)
- Na-Ra Lee
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY 40536, United States
| | - Satheesh Gujarathi
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Shobanbabu Bommagani
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Kiranbabu Siripurapu
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY 40536, United States
| | - Guangrong Zheng
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Linda P Dwoskin
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY 40536, United States.
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Krishnan S, Dozor AJ, Bacharier L, Lang JE, Irvin CG, Kaminsky D, Farber HJ, Gerald L, Brown M, Holbrook JT, Wise RA, Ryu J, Bose S, Yasin R, Saams J, Henderson RJ, Teague WG. Clinical characterization of children with resistant airflow obstruction, a multicenter study. J Asthma 2018; 56:611-617. [PMID: 29771599 DOI: 10.1080/02770903.2018.1477956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To characterize a cohort of children with airflow limitation resistant to bronchodilator (BD) therapy. METHODS Pulmonary function tests performed in children 6-17 years of age at 15 centers in a clinical research consortium were screened for resistant airflow limitation, defined as a post-BD FEV1 and/or an FEV1/FVC less than the lower limits of normal. Demographic and clinical data were analyzed for associations with pulmonary function. RESULTS 582 children were identified. Median age was 13 years (IQR: 11, 16), 60% were males; 62% were Caucasian, 28% were African-American; 19% were obese; 32% were born prematurely and 21% exposed to second hand smoke. Pulmonary diagnoses included asthma (93%), prior significant pneumonia (28%), and bronchiectasis (5%). 65% reported allergic rhinitis, and 11% chronic sinusitis. Subjects without a history of asthma had significantly lower post-BD FEV1% predicted (p = 0.008). Subjects without allergic rhinitis had lower post-BD FEV1% predicted (p = 0.003). Children with allergic rhinitis, male sex, obesity and Black race had better pulmonary function post-BD. There was lower pulmonary function in children after age 11 years without a history of allergic rhinitis, as compared to those with a history of allergic rhinitis. CONCLUSIONS The most prevalent diagnosis in children with BD-resistant airflow limitation is asthma. Allergic rhinitis and premature birth are common co-morbidities. Children without a history of asthma, as well as those with asthma but no allergic rhinitis, had lower pulmonary function. Children with BD-resistant airflow limitation may represent a sub-group of children with persistent obstruction and high risk for life-long airway disease.
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Affiliation(s)
- Sankaran Krishnan
- a Division of Pediatric Pulmonology, Allergy and Sleep Medicine , New York Medical College and Maria Fareri Children's Hospital at Westchester Medical Center , Valhalla , NY
| | - Allen J Dozor
- a Division of Pediatric Pulmonology, Allergy and Sleep Medicine , New York Medical College and Maria Fareri Children's Hospital at Westchester Medical Center , Valhalla , NY
| | - Leonard Bacharier
- b Division of Allergy, Immunology and Pulmonary Medicine , Washington University School of Medicine at St Louis , Seattle , WA
| | - Jason E Lang
- c Division of Pulmonary and Sleep Medicine, Dept. Of Pediatrics , Duke Univ. School of medicine , Durham , NC
| | - Charles G Irvin
- d Department of Medicine , University of Vermont , Burlington , VT
| | - David Kaminsky
- d Department of Medicine , University of Vermont , Burlington , VT
| | - Harold J Farber
- e Pediatric Pulmonology , Baylor College of Medicine and Texas Children's Hospital , Houston , TX
| | - Lynn Gerald
- f College of Public Health , University of Arizona , Tucson , AZ
| | - Mark Brown
- f College of Public Health , University of Arizona , Tucson , AZ
| | - Janet T Holbrook
- g Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD
| | - Robert A Wise
- h Pulmonary Medicine , Johns Hopkins University , Baltimore , MD
| | - Julie Ryu
- i Pulmonary Medicine, Rady Children's Hospital , University of California at San Diego , San Diego , CA
| | - Sonali Bose
- h Pulmonary Medicine , Johns Hopkins University , Baltimore , MD
| | - Razan Yasin
- g Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD
| | - Joy Saams
- g Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD
| | - Robert J Henderson
- g Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD
| | - William G Teague
- j Pediatric Pulmonology , University of Virginia , Charlottesville , VA
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Is there a role for inhaled anticholinergic therapy in asthma management? JAAPA 2018; 30:9-10. [PMID: 28858010 DOI: 10.1097/01.jaa.0000522144.52305.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anticholinergic therapy has long been a cornerstone of management of chronic obstructive pulmonary disease (COPD) but has not been included in treatment guidelines for asthma. In September 2015, tiotropium bromide was approved for use in adults with asthma; the indication has since been expanded to children ages 6 years and older. This article discusses appropriate patient selection and dosing, and the role of tiotropium bromide in asthma management.
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Dissanayake S, Nagel M, Falaschetti E, Suggett J. Are valved holding chambers (VHCs) interchangeable? An in vitro evaluation of VHC equivalence. Pulm Pharmacol Ther 2018; 48:179-184. [DOI: 10.1016/j.pupt.2017.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/06/2017] [Accepted: 10/08/2017] [Indexed: 10/18/2022]
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Cazzola M, Ora J, Rogliani P, Matera MG. Role of muscarinic antagonists in asthma therapy. Expert Rev Respir Med 2017; 11:239-253. [PMID: 28140686 DOI: 10.1080/17476348.2017.1289844] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Higher parasympathetic tone has been reported in asthmatics. In general, cholinergic contractile tone is increased by airway inflammation associated with asthma. Nevertheless, the role of muscarinic antagonists for the treatment of asthma has not yet been clearly defined. Areas covered: The use of SAMAs and LAMAs in asthma has been examined and discussed according with the published evidence. Particular attention has been given to the large Phase III clinical trial program designed to evaluate the efficacy and safety of tiotropium respimat added to standard treatment in adults, adolescents and children with persistent asthma across the spectrum of asthma severity. Expert commentary: The current evidence is that in patients with poorly controlled severe asthma despite the use of ICS and LABA, the addition of tiotropium significantly increases the time to the first severe exacerbation and provides a modest but sustained bronchodilation. Identical results should be produced using other LAMAs. In any case, the documentation that, at least in animal or in vitro models, LAMAs show significant anti-inflammatory and anti-proliferative capacities and are able to inhibit airway remodeling induced by allergens makes a strong presumption that the use of LAMAs in asthma may go beyond the simple bronchodilator effect.
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Affiliation(s)
- Mario Cazzola
- a Chair of Respiratory Medicine, Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Josuel Ora
- b Division of Respiratory Medicine, Department of Internal Medicine , University Hospital Tor Vergata , Rome , Italy
| | - Paola Rogliani
- a Chair of Respiratory Medicine, Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy.,b Division of Respiratory Medicine, Department of Internal Medicine , University Hospital Tor Vergata , Rome , Italy
| | - Maria Gabriella Matera
- c Chair of Pharmacology, Department of Experimental Medicine , Second University of Naples , Naples , Italy
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