PURPOSE: Tiotropium bromide is an anticholinergic agent. Its potential for inhibiting airway inflammatory mechanisms has been postulated by in vitro studies, but the relevance of these to clinical practice is not known. By evaluating the cell profile in the Bronchoalveolar lavage (BAL) fluid and pulmonary function tests (PFT) both pre-tiotropium and post-tiotropium administration, the effects of this drug in bronchial asthma can be studied.
METHODS: In a Double-blind randomized control trial, BAL and PFT were performed on 20 subjects of bronchial asthma and 9 controls, the asthmatics were then divided into two sub-groups: Group I subjects after their pre-treatment BAL received inhalational tiotropium bromide+fluticasone dipropionate and salmetrol combination and Group II subjects after their pre-treatment BAL received inhalational Placebo+fluticasone dipropionate and salmetrol combination.Subjects were on medication for six to eight weeks and then underwent re-bronchoalveolar lavage and PFT. The data were analyzed using paired and independent ‘t’ tests.
RESULTS: There were 11 and 9 subjects in group I and II respectively apart from 9 controls. BAL and PFT were repeated after (7 weeks+5 days). There was a significant decrease(p<0.01) in BAL total cells in Group-I (post-tiotropium). The absolute macrophage count also showed a significant decline(p<0.01) in group-I, but the same were not significant on an inter-group analysis. PFT revealed a significant decline in FEV1 %predicted(p<0.01), FVC/FEV1 %predicted(p<0.01) and FEF25-75 % predicted(p<0.01) and TLC(p<0.05) in both groups, but the same were not significant on an inter-group analysis.
CONCLUSION: The observation of a decrease in BAL total cell count and absolute macrophage count in the lower respiratory tracts of subjects receiving tiotropium bromide may indicate that tiopropium bromide may have an antiinflammatory effect in bronchial asthma.
CLINICAL IMPLICATIONS: The study emphasizes the need for further evaluation of inhaled tiotropium bromide as an anti-inflammatory drug in bronchial asthma.
DISCLOSURE: Pankaj Sayal, No Financial Disclosure Information; No Product/Research Disclosure Information