Frequency of Tiotropium Bromide Use and Clinical Features of Patients with Severe Asthma in a Real-Life Setting: Data from the Severe Asthma Network in Italy (SANI) Registry.

Purpose: Patients with uncontrolled asthma despite high doses of inhaled corticosteroid therapy plus another controller are defined as severe asthmatics. Tiotropium bromide respimat (TBR) is the only long-acting muscarinic antagonists (LAMA) approved for severe asthma. The aim of this study was to explore the frequency of severe asthmatics treated with TBR and characterize their clinical features in a real-life, registry-based setting.
Materials and Methods: Baseline data from the Severe Asthma Network in Italy (SANI) registry have been analyzed to determine the use of TBR and other LAMA, and to compare clinical, functional and inflammatory features associated with the use of LAMA.
Results: Among a total of 698 enrolled patients, 35.9% were treated with LAMA (23.3% TBR, 4.5% tiotropium bromide handihaler, 4.5% aclidinium, 3.4% glycopyrronium bromide 0.3% umeclidinium bromide). Age of asthma onset was higher in patients taking LAMA, whom, compared to others were more frequently former smokers. They also had a higher annual exacerbation rate, experienced worst asthma control, worst disease-related quality of life and poorer lung function. Bronchiectasis was more frequently found in LAMA users (25.9% vs 13.1%).
Conclusion: TBR is still underused in severe asthma in a real-life setting, while a relevant proportion of patients are treated with other LAMA that are not approved for severe asthma treatment. Patients taking LAMA have features characteristic of even more severe asthma.
Competing Interests: Prof. Dr. Francesco Blasi reports grants, personal fees from AstraZeneca and Insmed; received lecture-advisory board fees from Chiesi, GSK, Guidotti, Grifols, Menarini, Novartis, Pfizer, Vertex, and Zambon, outside the submitted work. Prof Pierluigi Paggiaro reports institutional support and personal grants for advisory boards and lectures from ALK-Abellò, AstraZeneca, Chiesi, GlaxoSmithKline, Guidotti, Menarini, Mundipharma, Novartis, and Sanofi. Prof. Giorgio Walter Canonica reports grants, personal fees from Menarini, Alk-Abellò, Anallergo, Boehringer Ingelheim, Chiesi, Circassia, Genentech, Guidotti Malesci, GSK, Meda, Merck, Merck Sharp & Dome, Novartis, Recordati-InnuvaPharma, Roche, Sanofi, Stallergenes, UCB Pharma, Teva, AstraZeneca, ThermoFischer, Valeas, Vibor Pharma. Dr. Enrico Heffler reports grants, personal fees and/or grants from AstraZeneca, Sanofi, Novartis, GSK, Circassia, and Nestlè Purina, outside the submitted work. The authors report no other conflicts of interest in this work.
(© 2020 Puggioni et al.)