Professor David Halpin discusses the role of acetylcholine in the pathogenesis of asthma and the efficacy and safety of the anticholinergic SPIRIVA® Respimat® for this condition
Professor David Halpin, a UK based consultant chest physician, considers the role of acetylcholine in the pathophysiology of asthma, the benefits of SPIRIVA® (tiotropium) Respimat® and its efficacy and safety as an add-on therapy in the treatment of patients with symptomatic asthma as evidenced in the PrimoTinA-asthma® studies*.
These were two replicate, 48-week studies examining the effects of tiotropium when added to patients' existing asthma medication of inhaled steroids (ICS) and long acting beta agonists (LABA) (ICS and LABA).1
The efficacy and safety of SPIRIVA® Respimat®in asthma
Despite treatment with ICS and LABA many patients remain symptomatic and continuing to experience exacerbations. This highlights the need for different treatment strategies to address this issue.1
Summarising his presentation Professor Halpin says: “We now recognise that acetylcholine is a key neurotransmitter involved in the pathophysiology of asthma. Tiotropium is a long acting antagonist of the M3 receptors and the PrimoTinA-asthma® studies have shown that this translates into important clinical benefits.
In patients already treated with ICS and LABA, adding tiotropium respimat resulted in improvements in lung function, improvements in asthma control, reduction in the risk of exacerbations.”
* The PrimoTinA-asthma® studies are a part of Boehringer Ingelheim’s large international UniTinA-asthma®phase III clinical trial programme.
Background – tiotropium in asthma
Professor David Halpin, Consultant Chest Physician at the Royal Devon and Exeter Hospital, UK, introduces his presentation about the role of tiotropium in asthma. In this section he highlights the need for different treatment strategies to address the lack of asthma control experienced by some patients despite receiving standard asthma therapy of ICS plus LABA.
The role of acetylcholine in the pathophysiology of asthma
Professor Halpin describes the role of acetylcholine in the pathophysiology of asthma and the recognition of acetylcholine as a potential treatment target. He concludes this section by explaining the mechanism of action (MoA) of tiotropium
Phase III PrimoTinA-asthma® trials – study design
The role of tiotropium in asthma when added to high-dose inhaled corticosteroid (ICS) maintenance therapy (budesonide ≥800 μg/day or equivalent) plus long-acting beta-agonist (LABA) or placebo was explored in a large Phase III clinical trial programme.1 In this section, Professor Halpin explains the design of the studies, the co-primary and secondary end-points as well as the main inclusion criteria and demographics of the study population at baseline.
Results from the PrimoTinA-asthma®trials
Professor Halpin describes the results of tiotropium vs placebo when added to ICS/LABA for both the co-primary and secondary endpoints.
The clinical use of tiotropium as an add-on therapy for asthma
In this section Professor Halpin considers the sub-groups who might respond better and those sub-groups who might respond less well to tiotropium. He indicates that the results from the studies show there is no significant difference between sub-groups.1
Safety profile of tiotropium vs placebo
In this section of the video Professor Halpin explores the safety profile of tiotropium and points out the there were no significant differences vs placebo and there were no deaths in either treatment group.
Summary and conclusions
Professor Halpin summarises the results and concludes that tiotropium is a useful therapeutic addition particularly for those asthma1 patients not controlled at Step 4 or Step 5 of the Global Initiative in Asthma (GINA) pathway and this explains why tiotropium has been positioned by GINA as an add-on option at Step 4 and Step 5.2