Abstract

An attempt is made to measure the improvement in the Pulmonary Function Test (especially the FEV1 and PEFR parameters), upon the addition of tiotropium bromide to the ongoing therapy of severe persistent asthmatics. The study is a Single blind prospective study within subject comparison carried out in a teaching hospital of Hyderabad during a time period of 6 months i.e., from July 2013 to January 2014. Severe persistent asthmatics were enrolled for the study and the data collection of the enrolled patients was done in the properly designed data collection forms. Spirometry and Peak Expiratory Flow rates of the enrolled patients before and after the addition of tiotropium bromide to the therapy were performed. Tiotropium in a dose of 18 mcg per day in a Metered Dose Inhaler and Rotahaler forms were used for nearly 5 weeks before performing the after Pulmonary Function Test (PFT). Out of 40 patients enrolled, 8 showed non-compliances, 9 patients showed very less improvement in the spirometric and clinical outcomes which is statistically not significant. Subjects (n=23) showed significant improvement in both clinically as well as spirometrically, in spirometric assessment, FEV1 is improved by 0.54L (Mean difference of percentage predicted=17.65%) and morning PEFR improved by I.96L (Mean difference of percentage predicted=22.32), with respect to baseline which is statistically significant (P<0.001). Clinically, the mean score reports showed 60-70% improvement when compared to baseline. In patients with poorly controlled asthma despite the use of inhaled glucocorticoids and LABAs, the addition of Tiotropium in the dose of 18 mcg once daily via dry powder inhaler resulted in 24 hr broncho dilation as well as consistent and sustained improvement for severe persistent asthma.