COPD drug could be used to treat asthma patients

Patients with poorly controlled asthma are a step closer to a new treatment option, after Phase III data showed that Boehringer Ingelheim’s lung drug Tiotropium, significantly reduced exacerbations and improved both lung function and quality of life.

The phase III research, presented at the European Respiratory Society conference in Vienna, also showed adding the once daily drug could cut the risk of any asthma exacerbation by 31%.

Tiotropium, a long-acting inhaled bronchodilator commonly used to treat chronic obstructive pulmonary disease (COPD), is currently unlicensed for treating asthma.

Spiriva, which is known chemically as Tiotropium is delivered by the Respimat Soft Mist inhaler. The research was published in the New England Journal of Medicine. Tiotropium has comprehensive clinical trial data, demonstrating an extensive wealth of experience since its introduction almost 10 years ago and over 25million patient years of real life experience, to support the efficacy and safety profile.

However, there remain concerns over the drug’s risk in patients with heart disease. Last year an analysis published by the British Medical Journal, found that the use of Spiriva delivered in a mist form (via Respimat), was linked with a 52% increase in the risk of death.

Boehringer Ingelheim said, “It did not agree with the authors conclusion that there is an increased mortality risk for Spiriva Respimat in COPD, and that its risks and benefits were included in its label.”

The German drug maker went on to say, “There were also significant improvements in lung function, asthma control and asthma related quality of life, lending further weight to the case for its use in controlling the disease. The need for new and effective asthma treatments is great, because a significant proportion of patients remain symptomatic and may experience asthma exacerbations, despite current therapies.”

In two trials supported by the drug’s marketers, Boehringer Ingelheim and Pfizer, researchers recruited 912 patients with asthma already taking inhaled glucocorticoids and long-acting beta-agonists (LABAs).

Despite their drug regimen, all patients remained symptomatic and had at least one severe exacerbation within the past year. Researchers randomised these patients to receive either Tiotropium once daily or placebo alongside their usual treatment. These were administered using a soft mist inhaler.

The team found that after 24 weeks patients receiving Tiotropium went on average 282 days without a first exacerbation, 21% longer than those on placebo, who experienced an exacerbation within an average of 226 days. The effects were sustained over 24 hours. Adverse events were similar between treatment and placebo groups.

The researchers concluded that, “In patients with poorly controlled asthma despite treatment with inhaled glucocorticoids and LABAs, adding Tiotropium significantly reduced the risk of episodes of the worsening of asthma and asthma exacerbations, requiring treatment with systemic glucocorticoids and provided sustained bronchodilation.”

Olympians prove there’s life after asthma

Many would assume that after being diagnosed with asthma, you would not be able to enjoy exercise or sport to the extent that non asthma sufferers do. However whilst it is true that exercise is a trigger for asthma sufferers, does that have to mean an end to sporting activities for asthma sufferers and does it have to spell the end of any sporting hopes and dreams they may have.

Well not according to our Olympians who achieved so much success at the London 2012 Olympics. Bradley Wiggins, 2012 tour de France winner and Olympic gold medalist said, “It does sound quite bad if you are diagnosed with asthma and your natural instinct is to think that’s it. But there is better medication available now and I am an Olympic champion, the evidence is out there that you can succeed.”

That view was echoed by British marathon runner, Paula Radcliffe, who said, “I don’t really think asthma has affected my career, if anything it’s made me more determined to be successful and reach my maximum potential. If you learn to manage your asthma and take the correct medication, there’s no reason why you shouldn’t be the best.”

Another Olympian who didn’t let asthma hold her back was swimmer, Karen Pickering. She said, “I was diagnosed with asthma aged seven, which was when my doctor told me that swimming would help my asthma by strengthening my lungs. Despite exercise being one of my asthma triggers, I persevered and always kept an inhaler at the end of my lane while I trained and in my tracksuit pocket as I went up for my races. I went on to compete in four consecutive Summer Olympics and won Commonwealth and World Championship gold medals.”

Other athletes with asthma who took part in this year’s Olympics were: Rebecca Adlington (swimmer), Laura Trott (cycling), Jo Jackson (swimmer), Jo Pavey (runner), Alex Gregory (rower), Andrew Badderley (runner), Greg Rutherford (long jump), Michael Rimmer (runner), Adam Gemili (runner), Laura Weightman (runner), Euan Burton (Judo), Pete Reed (rower), Tom James (rower), Craig Bellamy (footballer), Mhairi Spence (pentathlete), and Ashley McKenzie (judo).

Further statistics from the United States Olympic Committee that back this up are that, 25% of athletes in the 2012 Team GB athletics squad have asthma. 20% of the entire British Olympic Squad at the 2004 Athens Olympic Games had asthma. Half of cross-country skiers and one quarter of aspiring Winter Olympians in general, have exercise-induced asthma.

According to the charity Asthma UK, “Often people with asthma are worried about exercising, because they think it will trigger their asthma symptoms. Actually, the majority of people with asthma should be able to take part in any type of activity or exercise they enjoy, as long as their asthma is under control. By starting with gentle walking or swimming it can be possible to go on to building your stamina and achieving great sporting feats.”

In fact, besides saying that asthmatics can exercise, the charity goes on to say, “Eight out of ten people with asthma aren’t doing enough exercise, often because they’re worried it will trigger their symptoms. But actually exercise can help your asthma, so don’t let it hold you back!”

They continue, “Exercise can help improve your lung capacity, which will help you to manage your asthma better when you exercise, cope better with everyday chores, worry less about your asthma and give you the confidence to manage your condition. If you’re worried about starting to exercise, have a chat with your GP or asthma nurse first. They’ll be able to help you find the best type of exercise for you. Get them to check that your asthma is under control.”

So in conclusion asthma doesn’t have to stop asthmatics enjoying exercise or sport, as long as it is properly managed and controlled. If that’s good enough for Olympic gold medalists such as Bradley Wiggins then it certainly offers hope for the 5.4million asthma sufferers in the UK.