Forced Expiratory Flow (FEF25–75%) as a Clinical Endpoint in Children and Adolescents with Symptomatic Asthma Receiving Tiotropium: A Post Hoc Analysis

Research output: Contribution to journalComment/debateContributedpeer-review

Contributors

  • Stanley J. Szefler - , University of Colorado Denver (Author)
  • Stanley Goldstein - , Allergy and Asthma Care of Long Island (Author)
  • Christian Vogelberg - , Department of Paediatrics, TUD Dresden University of Technology (Author)
  • George W. Bensch - , Alphabet Inc. (Author)
  • John Given - , Aultman Hospital (Author)
  • Branko Jugovic - , Boehringer Ingelheim GmbH (Author)
  • Michael Engel - , Boehringer Ingelheim GmbH (Author)
  • Petra M. Moroni-Zentgraf - , Boehringer Ingelheim GmbH (Author)
  • Ralf Sigmund - , Boehringer Ingelheim GmbH (Author)
  • Eckard H. Hamelmann - , Epilepsy Center Bethel (Author)

Abstract

Introduction: In pediatric patients with asthma, measurements of forced expiratory volume in 1 s (FEV1) may be normal or may not correlate with symptom severity. Forced expiratory flow at 25–75% of the vital capacity (FEF25–75%) is a potentially more sensitive parameter for assessing peripheral airway function. This post hoc analysis compared FEF25–75% with FEV1 as an endpoint to assess bronchodilator responsiveness in children with asthma. Methods: Change from baseline in trough FEF25–75% and trough FEV1 following treatment with either tiotropium (5 µg or 2.5 µg) or placebo Respimat® was analyzed in four phase III trials in children (aged 6–11 years) and adolescents (aged 12–17 years) with symptomatic moderate (VivaTinA-asthma® and PensieTinA-asthma®) and mild (CanoTinA-asthma® and RubaTinA-asthma®) asthma. Data from all treatment arms were pooled and correlations between FEF25–75% and FEV1 were calculated and analyzed. Results: A total of 1590 patients were included in the analysis. Tiotropium Respimat® consistently improved FEF25–75% and FEV1 versus placebo, although in adolescents with severe asthma, the observed improvements were not statistically significant. Improvements in FEF25–75% response with tiotropium versus placebo were largely more pronounced than improvements in FEV1. Statistical assessment of the correlation of FEV1 and FEF25–75% showed moderate-to-high correlations (Pearson’s correlation coefficients 0.73–0.80). Conclusions: In pediatric patients, FEF25–75% may be a more sensitive measure to detect treatment response, certainly to tiotropium, than FEV1 and should be evaluated as an additional lung function measurement.

Details

Original languageEnglish
Pages (from-to)151-158
Number of pages8
JournalPulmonary Therapy
Volume6
Issue number2
Publication statusPublished - Dec 2020
Peer-reviewedYes

Keywords

Keywords

  • Airway obstruction, Asthma, Muscarinic antagonist, Tiotropium