Is Spiriva (Tiotropium) effective for treating asthma?

From the Guidelines

Spiriva (tiotropium bromide) is not typically recommended as a first-line treatment for asthma, but it may be considered as an add-on therapy for patients with severe asthma who are not adequately controlled with standard treatments, as evidenced by studies such as 1 and 1. The medication works as a long-acting anticholinergic bronchodilator that relaxes airway muscles by blocking acetylcholine receptors, providing 24-hour bronchodilation. Some key points to consider when prescribing Spiriva for asthma management include:

• The standard dosage is 2.5 micrograms (Respimat inhaler) or 18 micrograms (HandiHaler) once daily.
• Spiriva is not a rescue medication for acute symptoms and should not be used in place of a prescribed rescue inhaler for sudden breathing difficulties.
• Common side effects include dry mouth, throat irritation, and sinus infections.
• Patients should be aware that Spiriva may take 1-2 weeks of consistent use to show improvement in asthma control, though full benefits may take longer to develop. It's essential to weigh the potential benefits and risks of Spiriva in the context of individual patient needs and medical history, as noted in studies such as 1 and 1. In general, inhaled corticosteroids and long-acting beta agonists are the preferred treatments for asthma, as recommended by guidelines such as those outlined in 1 and 1. However, for patients with severe asthma who are not adequately controlled with these standard treatments, Spiriva may be a viable option to consider, as supported by evidence from studies like 1 and 1.

From the FDA Drug Label

STIOLTO RESPIMAT is not indicated to treat asthma. The safety and effectiveness of STIOLTO RESPIMAT in asthma have not been established. STIOLTO RESPIMAT is not indicated for the treatment of asthma [see Contraindications (4)] Use of a LABA, including STIOLTO RESPIMAT, without an inhaled corticosteroid is contraindicated in patients with asthma [see Warnings and Precautions (5.1)].

Spiriva (tiotropium) is not approved for the treatment of asthma. The FDA drug label clearly states that STIOLTO RESPIMAT (a combination of tiotropium and olodaterol) is not indicated for the treatment of asthma and its safety and effectiveness in asthma have not been established 2, 2, 2.

From the Research

Spiriva for Asthma

• Spiriva, also known as tiotropium, is a long-acting muscarinic antagonist used as an add-on maintenance treatment for patients with asthma aged ≥6 years at Global Initiative for Asthma (GINA) steps 4 and 5 3.
• The efficacy and safety of tiotropium add-on to inhaled corticosteroids (ICS) ± long-acting beta2-agonists (LABA) maintenance treatment have been evaluated in randomized controlled trials (RCTs) involving patients with a range of asthma severities and across age groups 3.
• Add-on tiotropium was found to be well tolerated and efficacious in all RCTs, with beneficial effects in reducing exacerbations, hospitalization, emergency room visits, and asthma worsening 3, 4, 5.

Comparison with Other Treatments

• A study compared the efficacy and safety of adding tiotropium or long-acting β2-agonists to inhaled corticosteroids in patients with asthma, and found that the proportion of patients who experienced a severe or moderate-or-severe exacerbation was similar between the two groups 4.
• Another study found that adding tiotropium to ICS was associated with a lower risk of exacerbations and improved lung function compared to adding a LABA to ICS 5.
• A review of studies found that long-acting beta2-agonists (LABA) were superior to anti-leukotrienes (LTRA) in reducing oral steroid-treated exacerbations in adults with asthma, but noted that there was some evidence of increased risk of serious adverse events with LABA 6.

Real-World Evidence

• Real-world studies have shown that add-on tiotropium can reduce exacerbations, hospitalization, emergency room visits, and asthma worsening in patients with asthma 3, 4, 5.
• A study found that add-on tiotropium significantly decreased the risk and rate of exacerbations, decreased all-cause and asthma-related emergency department visits and hospitalizations, and reduced short-acting beta-2-agonist refills compared with increasing the ICS plus LABA dose 5.