Oleh Admin Kalbe Medical pada March 15, 2017 07:30

Penambahan Tiotropium Bermanfaat Memperbaiki Gejala pada Asma Anak

Asma adalah penyakit peradangan kronik saluran napas yang ditandai oleh episode berulang dari batuk, sesak napas, dada tertekan, dan wheezing. Menurut WHO, asma adalah penyakit kronik yang paling banyak terjadi pada anak, sehingga apabila terjadi serangan asma akan menyebabkan banyak kehilangan hari sekolah. Menurut GINA (Global Initiative for Asthma), sebagai pengobatan asma pada anak ada beberapa pilihan seperti inhalasi kortikosteroid, beta agonis, montelukast, atau kombinasi dari beberapa bahan aktif tersebut. Akan tetapi, meskipun dengan kombinasi inhalasi kortikosteroid + beta agonis, sebagian pasien asma anak masih belum terkontrol sempurna.

Pada orang dewasa dan remaja dengan asma yang tidak terkontrol dengan kombinasi inhalasi kortikosteroid + beta agonis, telah dibuktikan bahwa penambahan tiotropium dapat bermanfaat untuk memperbaiki gejala asma. Namun, belum pernah ada penelitian serupa pada asma anak. Oleh karena itu, dr. Szefler dan tim dari USA melakukan sebuah uji klinik yang diterbitkan di Journal of Allergy and Clinical Immunology bulan Februari tahun 2017.


Pada uji klinik ini, sebanyak 401 anak (usia 6 sampai 11 tahun) dengan asma yang tidak terkontrol oleh pengobatan inhalasi kortikosteroid dosis tinggi atau inhalasi kortikosteroid + beta agonis diacak untuk mendapatkan tambahan berupa tiotropium 2 x 2,5 µg atau 2 x 1,25 µg atau 2 x plasebo. Eksperimen dilakukan secara acak, tersamar ganda, dan selama 12 minggu. Parameter yang dievaluasi adalah fungsi saluran napas yang diukur melalui 2 parameter, yaitu peak FEV1 (puncak Forced Expiratory Volume 1 detik pertama) dan through FEV1 (dasar Forced Expiratory Volume 1 detik pertama).


Hasil yang didapatkan adalah: penambahan tiotropium 2 x 2,5 µg bermanfaat meningkatkan rerata peak FEV1 secara bermakna (perbedaan rerata 139 mL; 95% CI, 75-203; P < 0,001) dan juga meningkatkan through FEV1 secara bermakna (perbedaan rerata 87 mL; 95% CI, 19-154; P = 0,01). Namun, didapatkan data bahwa penambahan tiotropium 2 x 1,25 µg tidak bermanfaat untuk meningkatkan rerata peak FEV1 (perbedaan rerata 35 mL; 95% CI, -28-99; P = 0,27) dan tidak bermanfaat untuk meningkatkan rerata through FEV1 (perbedaan rerata 18 mL; 95% CI, -48-85; P = 0,59). Selain itu, juga didapatkan bahwa kejadian tidak diinginkan pada kelompok tiotropium tidak berbeda bermakna dengan kelompok plasebo.


Kesimpulan:
Dari uji klinik ini disimpulkan bahwa penambahan tiotropium dosis 2 x 2,5 µg bermanfaat memperbaiki fungsi paru pada pasien anak dengan asma yang tidak terkontrol dengan pengobatan standar. (NNO)

Image : Ilustrasi
Referensi:
Szefler SJ, Murphy K, Harper T, Boner A, Laki I, Engel M, et al. A phase III randomized controlled trial of tiotropium add-on therapy in children with severe symptomatic asthma. J Allergy Clin Immunol. 2017 Feb 9;

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