From the Guidelines
Tiotropium (Spiriva) is a reasonable first choice for a Long-Acting Muscarinic Antagonist (LAMA) inhaler, as it has been extensively studied and provides 24-hour bronchodilation with once-daily dosing, which helps improve adherence 1. The typical dose is 18 mcg once daily using the HandiHaler device, or 2.5 mcg once daily using the Respimat inhaler. Tiotropium works by blocking muscarinic receptors in the airways, preventing acetylcholine from causing bronchoconstriction, thereby improving airflow and reducing symptoms like shortness of breath in conditions such as COPD and asthma.
Key Points
- Tiotropium has a well-established safety profile and is effective in reducing exacerbations and hospitalizations 1.
- Other reasonable LAMA options include umeclidinium (Incruse Ellipta, 62.5 mcg once daily), aclidinium (Tudorza Pressair, 400 mcg twice daily), and glycopyrrolate (Seebri Neohaler, 15.6 mcg twice daily) 1.
- When starting a LAMA, patients should be instructed on proper inhaler technique and advised that the full benefit may take several days to develop.
- Common side effects include dry mouth, constipation, and urinary retention, so caution is warranted in patients with narrow-angle glaucoma or prostatic hyperplasia.
Considerations
- The choice of LAMA may depend on individual patient factors, such as comorbidities and medication tolerability.
- Combination therapy with a LABA and LAMA may be considered for patients with severe COPD or those who experience exacerbations despite monotherapy 1.
- Regular monitoring and adjustment of therapy are necessary to optimize treatment outcomes and minimize adverse effects.
From the FDA Drug Label
Umeclidinium is a long-acting muscarinic antagonist, which is often referred to as an anticholinergic. Tiotropium is a long-acting, muscarinic antagonist which is often referred to as an anticholinergic.
A reasonable first choice for a Long-Acting Muscarinic Antagonist (LAMA) inhaler could be either umeclidinium or tiotropium, as both are classified as LAMAs and have similar mechanisms of action, exhibiting pharmacological effects through inhibition of M3 receptors at the smooth muscle leading to bronchodilation 2 3.
- Umeclidinium is available in combination with vilanterol in ANORO ELLIPTA.
- Tiotropium is available in combination with olodaterol in STIOLTO RESPIMAT. Both options should be considered based on individual patient needs and medical history.
From the Research
Long-Acting Muscarinic Antagonist (LAMA) Inhalers
- A reasonable first choice for a LAMA inhaler can be based on several factors, including efficacy, safety, and patient preference 4, 5, 6, 7.
- Tiotropium is a well-established LAMA that has been shown to be safe and efficacious as a long-term, once-daily treatment for COPD 4.
- Other LAMAs, such as aclidinium, glycopyrronium, and umeclidinium, have also demonstrated comparable efficacy to tiotropium 6.
- The choice of LAMA should depend on the physician's and patient's preference, as well as individual patient needs and response to treatment 6, 7.
Efficacy of LAMA Inhalers
- Studies have shown that LAMAs can improve lung function, health-related quality of life, and exercise endurance, and reduce dyspnea, lung hyperinflation, exacerbations, and use of rescue medication in patients with COPD 4, 5, 6.
- LAMAs have also been shown to be effective in reducing exacerbations and improving symptoms in patients with asthma who are uncontrolled on inhaled corticosteroids and long-acting β2-agonists 8.