Is Spiriva (tiotropium) inhaler only used for Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

No, Spiriva (tiotropium) is not only used for Chronic Obstructive Pulmonary Disease (COPD). While Spiriva was initially approved for COPD treatment, it is also FDA-approved for the long-term maintenance treatment of asthma in patients 6 years and older. Spiriva is a long-acting anticholinergic bronchodilator that works by blocking acetylcholine receptors in the airways, which helps relax airway muscles and improve breathing for up to 24 hours.

Key Points

• In COPD, Spiriva is typically prescribed as Spiriva HandiHaler (18 mcg once daily) or Spiriva Respimat (2.5 mcg, two inhalations once daily) 1.
• For asthma, it's usually prescribed as Spiriva Respimat at the same dosage.
• The medication helps reduce exacerbations and improve lung function in both conditions.
• Patients should be aware that Spiriva is not a rescue medication for acute symptoms but rather a controller medication for long-term management of these chronic respiratory conditions.

Treatment Guidelines

According to the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable COPD, LAMA/LABA single inhaled dual therapy is preferred over ICS/LABA inhaled combination therapy considering the additional improvements in lung function and the lower rates of adverse events such as pneumonia 1.

Important Considerations

• ICS/LABA combination therapy should be used in individuals with concomitant asthma.
• Triple inhaled ICS/LAMA/LABA combination therapy should preferably be administered in a single inhaler triple therapy (SITT), and not in multiple inhalers.
• The primary adverse effect attributed to the LABA/ICS combination is an increased risk of pneumonia, although this effect may not be present to the same degree with all formulations of a LABA/ICS 1.
• Adding a LAMA to the LABA/ICS combination appears to reduce the rate of severe exacerbations and improve symptoms in patients with moderate or severe COPD 1.
• LABA/LAMA combinations have been developed and appear to increase lung function to a greater degree than a LAMA alone 1.

From the FDA Drug Label

STIOLTO RESPIMAT is a combination of tiotropium bromide, an anticholinergic and olodaterol, a long-acting beta2-adrenergic agonist (LABA) indicated for the long-term, once-daily maintenance treatment of patients with chronic obstructive pulmonary disease (COPD). STIOLTO RESPIMAT is NOT indicated to treat acute deterioration of COPD. STIOLTO RESPIMAT is NOT indicated to treat asthma.

The Spiriva inhaler, which contains tiotropium, is not exclusively used for Chronic Obstructive Pulmonary Disease (COPD) according to the provided drug labels, but the labels provided are for a combination product, STIOLTO RESPIMAT, which includes tiotropium and olodaterol. However, other formulations of tiotropium, such as Spiriva, may have different indications. Key points:

• The provided labels are for STIOLTO RESPIMAT, a combination of tiotropium and olodaterol.
• STIOLTO RESPIMAT is indicated for the long-term, once-daily maintenance treatment of patients with COPD.
• It is not indicated for asthma or acute deterioration of COPD. Since the question is about Spiriva (tiotropium) inhaler and the provided labels are for a combination product, no conclusion can be drawn about Spiriva's indications from these labels. 2 2

From the Research

Spiriva Inhaler Usage

• The Spiriva (tiotropium) inhaler is not only used for Chronic Obstructive Pulmonary Disease (COPD) 3, 4.
• It is also approved for the add-on maintenance treatment of asthma in adults currently receiving maintenance therapy with an inhaled corticosteroid (ICS) and a long-acting β2-adrenergic agonist (LABA) 3.
• Tiotropium Respimat® added to maintenance ICS/LABA treatment significantly improved lung function and extended the time to the first asthma exacerbation in patients with poorly controlled asthma 3.
• The drug was well tolerated in asthma patients throughout 48 weeks' treatment, with a generally similar incidence of serious adverse events in tiotropium Respimat® and placebo treatment groups 3.

COPD Treatment

• Inhaled bronchodilator therapy with long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) in combination is currently the mainstay of treatment for COPD 5.
• Tiotropium, a LAMA, provides similar benefits in reducing exacerbations as combination inhalers, and is often used in the treatment of COPD 6, 7.
• The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020 report recommends dual bronchodilator therapy as both an initial and follow-up treatment option for COPD 7.

Key Differences in Usage

• The recommended dose of tiotropium for asthma is 2.5 μg once daily, which is lower than the dose approved for COPD 4.
• Tiotropium Respimat® represents the first new class of drug approved by the U.S. Food and Drug Administration for the treatment of asthma in more than a decade 4.