The quality of evidence is downgraded by imprecise results (wide confidence intervals and few outcome events).
A Cochrane review «Long‐acting muscarinic antagonists (LAMA) added to combination long‐acting beta2‐agonists and inhaled corticosteroids (LABA/ICS) versus LABA/ICS for adults with asthma»1 «Kew KM, Dahri K. Long-acting muscarinic antagonists (LAMA) added to combination long-acting beta2-agonists and inhaled corticosteroids (LABA/ICS) versus LABA/ICS for adults with asthma. Cochrane Datab»1 included 3 studies with a total of 1 197 subjects with asthma taking combination long-acting beta-agonist and inhaled corticosteroid (LABA+ICS). People in the studies had a mean forced expiratory volume in one second (FEV1) of 55% of their predicted value, indicating severe asthma. People randomised to take tiotropium add-on seemed to have fewer exacerbations requiring oral corticosteroids and fewer exacerbations requiring hospital admission than those continuing to take LABA+ICS alone, but the confidence intervals did not rule out no difference over 48 weeks (table «Tiotropium versus placebo in adults with asthma taking background LABA+ICS»1). Lung function tests (FEV1 and FVC) were slightly better with tiotropium. There was no difference in quality of life. People taking tiotropium add-on were less likely to experience non-serious or serious adverse events.
| Outcome | Relative effect (95% CI) | Risk with placebo | Risk with tiotropium (95% CI) | Participants (studies) |
|---|---|---|---|---|
| Exacerbations requiring oral corticosteroids | OR 0.76 (0.57 to 1.02) | 328 per 1000 | 271 per 1000 (218 to 333) | 907 (2) |
| Exacerbations requiring hospital admission | OR 0.68 (0.34 to 1.38) | 43 per 1000 | 30 per 1000 (15 to 59) | 1 191 (3) |
| Any adverse events | OR 0.70 (0.52 to 0.94) | 813 per 1000 | 753 per 1000 (693 to 803) | 1 197 (3) |
| Serious adverse events | OR 0.60 (0.24 to 1.47) | 96 per 1000 | 60 per 1000 (25 to 134) | 1 197 (3) |
Date of latest search: 8 January 2016