Spiriva

Spiriva is the brand name for tiotropium bromide, a long-acting muscarinic antagonist (LAMA) used as a maintenance bronchodilator for the treatment of chronic obstructive pulmonary disease (COPD) and, in the Respimat formulation, as add-on therapy for adult asthma patients who remain symptomatic despite treatment with inhaled corticosteroids and long-acting beta-2 agonists.

Tiotropium selectively blocks muscarinic M3 receptors in the airway smooth muscle.

By preventing acetylcholine from binding to these receptors, it inhibits bronchoconstriction and mucus secretion, resulting in sustained bronchodilation.

Tiotropium dissociates very slowly from M3 receptors, which accounts for its prolonged duration of action, allowing effective 24-hour symptom control with a single daily dose.

Spirva has a strong evidence base from large clinical trials including UPLIFT and POET-COPD.

It has been shown to improve lung function, reduce exacerbation rates, and enhance quality of life in COPD patients.

It is available as the HandiHaler (dry powder capsule device) and the Respimat (soft-mist inhaler).

For the HandiHaler: place one capsule in the device, pierce it by pressing the green button, breathe out fully, then inhale deeply and slowly through the mouthpiece.

Hold your breath for as long as comfortable. Repeat the inhalation to ensure the capsule is emptied. For the Respimat: inhale 2 puffs once daily at the same time each day.

Spiriva is for regular daily use and should not be used for acute breathlessness.

HandiHaler: one 18-microgram capsule inhaled once daily. Respimat: two puffs (each delivering 2.5 micrograms) once daily, providing a total daily dose of 5 micrograms.

For asthma (Respimat only): two puffs of 2.5 micrograms once daily as add-on to ICS/LABA therapy.

No dose adjustment is required in elderly patients or those with renal or hepatic impairment, although patients with moderate to severe renal impairment should be monitored.

Common (1 in 10 to 1 in 100): dry mouth, pharyngitis, cough, oral candidiasis.

Uncommon (1 in 100 to 1 in 1,000): dizziness, headache, insomnia, blurred vision, atrial fibrillation, dysphonia, constipation, gastro-oesophageal reflux, urinary difficulty, urinary tract infection.

Rare (1 in 1,000 to 1 in 10,000): urinary retention, supraventricular tachycardia, glaucoma, dental caries, angioedema. Very rare (less than 1 in 10,000): anaphylaxis.

Dry mouth is the most commonly reported side effect and is usually mild.

Tiotropium should be used with caution in patients with narrow-angle glaucoma, prostatic hyperplasia, or bladder neck obstruction, as anticholinergic agents may worsen these conditions.

Eye pain, blurred vision, or visual halos require urgent assessment to exclude acute angle-closure glaucoma. Inhaled medications may trigger paradoxical bronchospasm.

Patients with moderate to severe renal impairment receiving tiotropium should be monitored closely, as systemic exposure may be increased.

Spiriva is not indicated for the initial rescue treatment of acute bronchospasm.

Spiriva is contraindicated in patients with known hypersensitivity to tiotropium bromide, atropine or its derivatives, or any of the excipients.

HandiHaler capsules contain lactose and should not be used by patients with a severe lactose or milk protein allergy.