Starting Your Treatment With Spiriva

Spiriva, also known as tiotropium, is a common drug used in chronic obstructive pulmonary disease (COPD). The following will highlight what to expect when starting your treatment with tiotropium.

How does tiotropium work?

Tiotropium is in a class of medications known as long-acting anticholinergics.¹ These drugs help dilate the airways; however, these drugs do not act as rescue therapy. Furthermore, tiotropium is not a steroid.

It has been demonstrated that tiotropium can:¹

• Improve shortness of breath
• Reduce exacerbations
• Improve nightly oxygen saturation
• Improve quality of life

How long before I see a response?

The maximum benefits of tiotropium may take up to 4 to 8 weeks.² It is important not to be discouraged if you don’t see an improvement in your breathing right away.

Different formulations

The drug is available in two different formulations: a dry powder inhaler (handihaler) and a soft mist inhaler (respimat). Each formulation has distinct dosing.

Spiriva HandiHaler

The handihaler is a dry powder inhaler.³ The typical dose is 1 capsule, or 18mcg of tiotropium, inhaled once daily. It is important to never swallow the capsule orally.

To use the handihaler, begin by unwrapping the blister to expose only one capsule.³ You don’t want to expose more than 1 capsule to air at a time. Take out the capsule and immediately place it in the inhaler. Close the mouthpiece until a click is heard. In order to get the medication out of the capsule, you need to pierce the capsule. This is done by pressing the green button on the inhaler.

When you are ready for your dose, exhale out and then place your lips on the mouthpiece and inhale deeply and rapidly.³ This type of breathing is important to ensure that you get all the medication out of the capsule and into your lungs. You may hear the capsule rattling; that is normal. Repeat this twice so that you can get all the contents of the capsule out.

Spiriva Respimat

The Respimat is known as a soft-mist inhaler, meaning that it delivers a slow-moving mist into your lungs. The typical dose is 2 inhalations once daily, to a maximum of 2 inhalations in a 24-hour period.⁴

Before you can use the Respimat, there will be a cartridge that you need to insert into the inhaler. It takes a lot of force to insert this in; if you have problems with hand mobility, ask your pharmacy team to insert it for you.

Prime each new inhaler by following the instructions on the box. Priming helps ensure that the right amount of medication is delivered to your lungs.

Which type of inhaler is better?

Studies have shown that the efficacy of these two inhalers is overall the same.⁵ However, there may be certain advantages of each based on patient preference. For example, unlike with the handihaler, people using the Respimat don’t need to breathe rapidly and forcefully to ensure the drug is delivered to the lungs. This may be easier for people who can’t get a strong breath in.

Side effects

Both inhalers share similar side effects. The following are the most common undesired effects that one can experience from tiotropium use (3,4):

• Dry mouth – this occurs in 4-16% of people
• Sore throat and upper tract infections
• Chest pain
• High blood pressure
• Rapid heart rate
• Difficulty urinating

Starting a new medication can be an overwhelming and scary experience. Connecting with individuals who have been on treatment can help minimize fears.

Have you tried both the respimat and handihaler formulations of tiotropium? What is your preference? Share your experiences by clicking the button below!