Abstract Rationale Asthma is a chronic airway inflammatory disorder and is characterized by recurring respiratory symptoms and reversible airflow obstruction. Studies suggest that tiotropium bromide and montelukast should be used individually if asthma control is not achieved with inhaled corticosteroids (ICS) plus long-acting beta-agonists (LABA). However, the effect of tiotropium bromide on lung function in asthmatic patients whose symptoms are uncontrolled with the combination of ICS plus LABA and montelukast has not been investigated. Therefore, this study aimed to assess whether the addition of tiotropium bromide to ICS plus LABA and montelukast in combination can further improve lung function in patients with uncontrolled asthma Methods In this retrospective study, we manually reviewed the electronic medical records of all patients with a confirmed asthma diagnosis who visited the pulmonary clinic at King Abdulaziz University Hospital and performed pulmonary function tests. Results Of 99 patients, 60 were asthmatic and were included in this study. Our findings showed that ICS plus LABA with either montelukast or tiotropium bromide did not affect spirometry values, peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), ratio of FEV1 to forced vital capacity (FEV1/FVC), FVC, and forced expiratory flow at 25 and 75% of the pulmonary volume (FEF25-75%). Although the addition of montelukast and tiotropium bromide either individually or in combination to ICS plus LABA did not cause any spirometric changes in patients with asthma as compared with ICS plus LABA alone, a trend of increase in spirometric values was observed when the add-on therapy (tiotropium bromide) was added together with regular asthma controller therapy (ICS plus LABA and montelukast) with a significant increase in FEF25-75% in patients with asthma as compared with ICS plus LABA and montelukast alone. It was also interesting to find that 23 out of 60 patients with asthma are still using SABA Conclusions Our findings demonstrate that spirometric measurements, FEF25-75% in particular, were improved by the addition of tiotropium bromide to ICS plus LABA and montelukast, but not by other asthma controller combinations, suggesting that tiotropium bromide should be added to asthmatic patients who routinely use ICS plus LABA and montelukast to improve obstructive peripheral airflow limitation. This abstract is funded by: None
Aldabayan et al. (Fri,) studied this question.