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Neonatal and pediatric inhalation drug delivery
Published in Anthony J. Hickey, Heidi M. Mansour, Inhalation Aerosols, 2019
Soft mist inhalers are propellant-free inhalation devices that use the energy of a spring to force liquids through a small nozzle (73). The aerosol plume of Respimat™ (Boeringher Ingelheim) is slower and lasts longer than pMDIs (74). Because of these characteristics and the deposition data, it is recommended that a VHC not be used (75). However, children younger than 5 years old have difficulty handling the device; thus, the use of a VHC is recommended (76). However, there is only one formulation approved in the United States for asthmatic children 12 years and older (tiotropium bromide) (77). Practitioners need to check that the child is able to coordinate actuation and inhalation, and inhale the mist for 1.5 seconds.
Management of Adult Asthma
Published in Jonathan A. Bernstein, Mark L. Levy, Clinical Asthma, 2014
Pallavi Bellamkonda, Thomas B. Casale
Finally, one can also consider the addition of tiotropium bromide. Recent studies indicate that the addition of tiotropium bromide improved FEV1 and PEFs to a greater degree than LABA or doubling the dose of ICS.17 Similar to LABAs, tiotropium improved asthma-control days over doubling the dose of ICS. More recently, adding tiotropium to maintenance therapy with high-dose ICS with LABA has been shown to improve the pulmonary function of patients with severe uncontrolled asthma.18
Efficacy and safety of add-on tiotropium in the management of uncontrolled asthma: a patient case series
Published in Journal of Asthma, 2022
Giselle Mosnaim, md, Brian K. Bizik, md, Christy Wilson, pa-c, Gregory Bensch, pa-c
The degree of obstruction is measured by a positive bronchodilator response, which is defined as an increase of ≥12% and ≥200 ml in FEV1 or FVC from baseline (26). Our final case report of a 29-year-old female patient had a post-bronchodilator change in FEV1 of 7% at presentation and indicated a patient subtype with fixed obstructive asthma. Such patients have severe airway obstruction (27), indicated by an FEV1/FVC ratio of <0.7 and no change in postbronchodilator FEV1% (1). These patients may exhibit characteristics of an asthma-COPD overlap. Given the efficacy of tiotropium in COPD, tiotropium could be an effective add-on therapy in this subset of patients (28). It is important to note that tiotropium bromide when administered for the treatment of COPD in 5 µg (2 puffs of 2.5 µg per puff, once daily (6)) differs from the dosage approved for asthma (2.5 µg; 2 puffs of 1.25 µg per puff, once daily (6)). Moreover, tiotropium has not specifically been studied in a randomized controlled trial for patients with asthma and COPD overlap (ACO).
Evaluating revefenacin as a therapeutic option for chronic obstructive pulmonary disease
Published in Expert Opinion on Pharmacotherapy, 2020
Sabina Antonela Antoniu, Ruxandra Rajnoveanu, Ruxandra Ulmeanu, Florin Mihaltan, Mihaela Grigore
LAMAs can be used as monotherapy in COPD with a lower disease burden, that is, less severe dyspnea, better quality of life, better lung function, and no or less severe disease exacerbations. Tiotropium bromide is the first LAMA approved in both the USA and EU for maintenance therapy in COPD. Tiotropium bromide demonstrated its therapeutic potential on both short- and long-term bases [3–5]. It was previously developed as capsules for daily inhalation route (delivering device, HandiHaler) and is currently marketed as a solution for inhalation delivered via a soft mist inhaler, called Respimat, with the same dosing schedule and comparable efficacy [6]. Subsequent LAMAs that became available for COPD were all formulated for dry powder inhalation and represented by aclidinium bromide, umeclidinium bromide, and glycopyrronium bromide, formulated for once or twice daily inhalations.
Benralizumab for the add-on maintenance treatment of patients with severe asthma aged 12 years and older with an eosinophilic phenotype
Published in Expert Review of Clinical Pharmacology, 2018
Khalid Al Efraij, J. Mark FitzGerald
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by a history of respiratory symptoms (e.g. cough, wheezing, chest tightness, and shortness of breath) that vary over time and in intensity, together with variable expiratory airflow limitation [1]. Most patients with asthma have mild-to-moderate disease that can be well controlled with standard treatment, including inhaled corticosteroids (ICS), and if the disease is more symptomatic, the addition of a long-acting beta agonist (LABA). The addition of a leukotriene receptor antagonist or tiotropium bromide may also improve asthma control and reduce the risk of an exacerbation. Despite these therapies, 5–10% of patients with asthma remain refractory [2]. These patients contribute to approximately 50% of the economic costs associated with asthma due to hospital admissions, use of emergency services, and unscheduled physician visits [3].