Spiolto Respimat

Spiolto Respimat is a combination inhaler containing tiotropium bromide and olodaterol, prescribed for the long-term maintenance treatment of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.

It is intended for patients who are not adequately controlled on a single long-acting bronchodilator.

Tiotropium is a long-acting muscarinic antagonist (LAMA) that blocks acetylcholine receptors in airway smooth muscle, producing sustained bronchodilation lasting at least 24 hours.

Olodaterol is a long-acting beta-2 agonist (LABA) that relaxes airway smooth muscle through a complementary pathway.

Together, these two bronchodilators provide greater improvement in lung function and breathlessness than either agent alone.

The Respimat soft-mist inhaler delivers the medication as a slow-moving, long-lasting aerosol cloud.

This makes inhalation easier compared with pressurised metered-dose inhalers, as less hand-breath coordination is required. The fine mist also achieves good lung deposition.

Inhale two puffs from the Spiolto Respimat inhaler once daily, at the same time each day.

Before first use, prime the inhaler by pointing it towards the ground and pressing the dose-release button until a visible spray appears, then repeating three more times.

If the inhaler has not been used for more than seven days, release one puff towards the ground before use.

Breathe out gently away from the inhaler, close your lips around the mouthpiece, and press the dose-release button while breathing in slowly and deeply.

Hold your breath for ten seconds or as long as comfortable. Wait at least one minute before taking the second puff. Rinse your mouth with water afterwards to reduce throat irritation.

The recommended dose is two puffs (2.5 micrograms tiotropium plus 2.5 micrograms olodaterol per puff; total daily dose 5 micrograms of each) inhaled once daily. Do not exceed two puffs in 24 hours.

No dose adjustment is required for elderly patients or those with mild to moderate renal impairment. Use with caution in severe renal impairment.

Each cartridge provides 60 puffs, lasting 30 days when used as directed.

Common side effects (1 in 10 to 1 in 100 patients) include dry mouth, nasopharyngitis, and cough.

Constipation, dizziness, headache, and urinary retention may also occur, reflecting the anticholinergic component.

Uncommon side effects include palpitations, tachycardia, pharyngitis, dysphonia (hoarse voice), and muscle spasms.

Blurred vision and increased intraocular pressure are possible if the spray contacts the eyes.

Rare but serious adverse effects include paradoxical bronchospasm (sudden worsening of breathing immediately after inhalation), angioedema, severe allergic reactions, and cardiac arrhythmias.

Hypokalaemia may occur with the olodaterol component, particularly when combined with other beta-agonists, corticosteroids, or diuretics.

Seek immediate medical attention for sudden breathing difficulty, facial swelling, or chest pain.

Spiolto Respimat is a maintenance treatment and must not be used as a rescue inhaler for acute breathlessness. Keep a separate short-acting bronchodilator available for emergencies.

Patients with narrow-angle glaucoma or urinary retention due to prostatic hyperplasia should use this inhaler with caution. Avoid getting the spray in the eyes.

If you notice visual disturbances, eye pain, or haloes around lights, stop the medication and seek medical advice.

Monitor potassium levels if you are taking diuretics or corticosteroids concurrently.

Spiolto Respimat is contraindicated in patients with known hypersensitivity to tiotropium, olodaterol, atropine or its derivatives, or any excipient in the formulation.

It should not be used in asthma, as LABA-containing products without an inhaled corticosteroid may increase the risk of asthma-related hospitalisation. Spiolto Respimat is intended for COPD only.