Spiriva

Spiriva is a long-acting anticholinergic (LAMA) from Boehringer Ingelheim used for the maintenance treatment of COPD and severe asthma. The active ingredient tiotropium widens the bronchi and keeps them open for 24 hours.

What makes Spiriva special: it only needs to be inhaled once a day and provides even protection throughout the entire day and night. In asthma, it is used in addition to existing therapy with an inhaled corticosteroid.

Spiriva is available as Respimat® (soft mist inhaler) and as HandiHaler® (dry powder inhaler).

Tiotropium blocks muscarinic receptors in the airways:

Mechanism of action:

• Inhibits the muscarinic receptors M1 and M3 in the bronchial muscles
• Blocks the effect of acetylcholine
• The smooth muscle relaxes
• The airways stay open

Special features:

• Very long binding time at the receptor (24+ hours)
• Dissociates slowly from the M3 receptor
• Dissociates faster from the M2 receptor (fewer side effects)
• Acts mainly in the airways, but part of the inhaled active substance reaches the bloodstream

Time course:

• Onset of action: within 30 minutes
• Maximum effect: 1-3 hours
• Duration of action: 24 hours

Spiriva is suitable for:

• Maintenance therapy of COPD (all severity levels)
• Severe asthma as add-on therapy
• When ICS + LABA do not provide adequate control

Indications:

• Chronic obstructive pulmonary disease (COPD)
• Severe asthma (steps 4-5 of the GINA guidelines)
• As an add-on to an ICS/LABA combination

Not suitable:

• As the sole asthma therapy
• For acute treatment of shortness of breath
• In children under 6 years of age

Spiriva Respimat (soft mist inhaler):

• 2.5 µg per puff (2 puffs = 5 µg/day)
• COPD: 2 puffs once daily
• Asthma: 2 puffs once daily

Spiriva HandiHaler (powder):

• 18 µg per capsule
• Inhale 1 capsule once daily

Dosing:

• Always at the same time of day
• Preferably in the morning
• Do not double the dose if you forget one

Spiriva Respimat: 1. On first use: pull off the base, insert the cartridge and press the inhaler down on a firm surface until the cartridge clicks into place, put the base back on. Then turn the base (cap closed), open the cap and press the button with the opening pointing towards the floor. Repeat this until a mist is visible, then 3 more times 2. With the cap closed, turn the base in the direction of the arrows until it clicks (half turn), then open the cap 3. Breathe out deeply (not into the inhaler) 4. Close your lips around the mouthpiece 5. Breathe in slowly and deeply while pressing the button 6. Hold your breath for 10 seconds 7. Inhale the second puff in the same way

Spiriva HandiHaler: 1. Open the dust cap 2. Flip the mouthpiece up 3. Place the capsule in the chamber 4. Close the mouthpiece, press the side button (the capsule is pierced) 5. Breathe out deeply, close your lips around the mouthpiece 6. Breathe in forcefully and deeply 7. Hold your breath for 10 seconds 8. Repeat the process to empty the capsule completely

Important:

• Always at the same time (preferably in the morning)
• Do not use as an emergency medication
• Rinse your mouth after inhalation

Spiriva must not be used in cases of:

• Hypersensitivity to tiotropium or atropine derivatives

Children: In children under 6 years of age, safety and efficacy have not been established. In COPD, Spiriva has no relevant benefit for children and adolescents under 18 years of age.

Caution in:

• Narrow-angle glaucoma
• Prostatic hyperplasia with urinary retention
• Severe renal impairment
• Cardiac arrhythmias

Pregnancy: Only if clearly indicated. Limited data available.

Breastfeeding: It is unknown whether tiotropium passes into breast milk. Benefit-risk assessment.

Common (1-10%):

• Dry mouth

Uncommon:

• Headache
• Pharyngitis (inflammation of the throat)
• Cough
• Dizziness
• Blurred vision
• Cardiac arrhythmias
• Constipation
• Urinary retention

Rare:

• Narrow-angle glaucoma
• Allergic reactions
• Paradoxical bronchospasm

Note: Dry mouth is the most common side effect. It can be relieved by drinking fluids and rinsing your mouth.

Caution when combined with:

• Other anticholinergics (additive effect)
• Medications that cause dry mouth

No relevant interaction:

• With beta-2 agonists (useful combination)
• With inhaled corticosteroids
• With most oral medications

Note: When used together with LABA and ICS: the combination is standard in severe asthma and COPD.