The impact of tiotropium for exercise induced bronchoconstriction

Background: Exercise induced bronchoconstriction (EIB) occurs frequently among athletes. Standard prevention plus pharmacological treatment cannot relieve EIB induced symptom in a part of patients. The usefulness of tiotropium on uncontrolled EIB has so far remained unclear. In this study, we report 8 cases of the difficult-to-control EIB treated with tiotropium. Objective: To examine the impact of tiotropium on the difficult-to-control EIB. Methods: In total, 8 cases of EIB were enrolled in this study. All the patients cannot achieve symptom-control with standard prevention and pharmacological treatment with rescue use of inhaled short-acting beta 2-agonist (SABA) and maintenance with inhaled corticosteroid plus long-acting beta 2-agonist. The delivered dose of tiotropium 5 microgram via respimat inhaler was added on maintenance medication. Symptom and the frequency of additional SABA use were compared before and 2 to 4 weeks after the initiation of tiotropium. Symptom was evaluated with visual analog scale (VAS) scale. More than 50% reduction of VAS scale plus rescue SABA use were defined “effective”. Results: Demographics of 8 cases were follows: mean age was 43 (15 - 56), 4 males, smoking status: one current, 2 former, and 5 never smokers, %FEV1 was 92.0 (78.2 - 106.4)％, Fe-NO 22 (14 - 30) ppb. Tiotropium was effective on 6 among 8 cases of difficult-to-control EIB. Conclusions: Tiotropium could be a useful choice to manage difficult-to-control EIB.