Journal Club - Mometasone or Tiotropium in Mild Asthma (low sEOS)

Location: 

Calgary, Alberta

Date: 

Aug 20, 2019

Discussion topic and resource: Mometasone or Tiotropium in Mild Asthma with a Low Sputum Eosinophil Level.

Reference: New England Journal of Medicine, Downloaded from nejm.com at Boehringer-Ingelheim Pharma KG on May 23, 2019.  S.C. Lazarus et al. pg 1-11

Lead by:  Dr. Olga Tourin MD, FRCP, FCCP, FACP, Dipl ABIM (IM)

Duration: 30 minutes

Discussion:  This study involved 295 patients with mild persistent asthma.  Out of those patients 73% had low sputum eosinophil levels (<2% in their sputum) and of those 73%, 59% had a response to either Mometasone or tiotropium vs placebo.   The Mometasone group did not have as much of a spread between Mometasone use responders versus the placebo use responders (57% vs 43%, however the tiotropium group had a more noticeable spread. Tiotropium use responders there as 60% versus the placebo use responders of 40%. This brings up the interesting point that Tiotropium may be the more effective treatment in controlling symptoms in those patients with low sputum eosinophil instead of the recommended ICS treatments currently. 

The response to Mometasone in those patients that has greater than 2% sputum eosinophils was better that  the reposnse by patients who where on placebo however the response in this population of patients was less noticeable in the Tiotropium user group.  This may indicate the possibility of using ICS in those patients with mild persistent asthma with sputum eosinophils as a more effective treatment to manage symptoms. 

This study’s data does not support the current treatment recommendations, however for those patients with low sputum eosinophils, specific treatment for this population of asthma patients has yet to be determined; indicating the need for further studies on the subject.