From the Guidelines
Spiriva (Tiotropium) is a long-acting muscarinic antagonist (LAMA) that should be used as a first-line treatment for chronic obstructive pulmonary disease (COPD) to improve lung function, reduce symptoms, and decrease exacerbation rates, as evidenced by the most recent and highest quality study 1.
Mechanism of Action and Benefits
Spiriva works by relaxing the muscles around the airways in the lungs, making breathing easier by preventing airway constriction 1. The medication blocks acetylcholine receptors in airway smooth muscle, preventing bronchoconstriction and reducing mucus secretion, which helps maintain open airways and improves lung function over time 1.
Dosage and Administration
The standard dose for COPD is typically 18 mcg once daily using the HandiHaler device, or 2.5 mcg once daily using the Respimat inhaler 1. For asthma, Spiriva Respimat is usually prescribed at 2.5 mcg once daily 1. Proper inhalation technique is crucial for effectiveness—patients should breathe out completely before inhaling the medication slowly and deeply, then hold their breath for about 10 seconds 1.
Comparison with Other Treatments
A systematic review by Chong et al compared tiotropium with long-acting β-agonists in the treatment of stable COPD, and found that tiotropium was associated with a lower rate of exacerbations compared with long-acting β-agonists 1. However, the strength of this evidence was deemed moderate due to a serious risk of bias 1.
Side Effects and Precautions
Common side effects of Spiriva include dry mouth, sinus infection, and throat irritation 1. Spiriva should not replace rescue inhalers for sudden breathing problems 1. Patients should be monitored for any adverse effects and instructed on proper inhalation technique to minimize risks 1.
Key Points
- Spiriva is a LAMA that improves lung function, reduces symptoms, and decreases exacerbation rates in COPD patients 1
- The standard dose for COPD is 18 mcg once daily using the HandiHaler device, or 2.5 mcg once daily using the Respimat inhaler 1
- Proper inhalation technique is crucial for effectiveness 1
- Spiriva should not replace rescue inhalers for sudden breathing problems 1
From the FDA Drug Label
Tiotropium is a long-acting, muscarinic antagonist which is often referred to as an anticholinergic. It has similar affinity to the subtypes of muscarinic receptors, M1 to M5. In the airways, it exhibits pharmacological effects through inhibition of M3-receptors at the smooth muscle leading to bronchodilation The use of Spiriva (Tiotropium) is for bronchodilation in patients with COPD (Chronic Obstructive Pulmonary Disease), as it acts as a long-acting muscarinic antagonist to inhibit M3-receptors and provide bronchodilation. 2
From the Research
Use of Spiriva (Tiotropium)
- Spiriva (Tiotropium) is a long-acting inhaled anticholinergic bronchodilator used for the treatment of chronic obstructive pulmonary disease (COPD) 3, 4, 5, 6, 7.
- It is designed for once-daily bronchodilator treatment of COPD, producing a long-lasting (24 hours), dose-dependent bronchodilation and bronchoprotection against constrictive stimuli 3.
- Tiotropium has been shown to improve lung function, reduce the frequency of COPD exacerbations and hospitalizations, and improve quality of life in patients with COPD 3, 4, 5, 6, 7.
- It has a unique kinetic selectivity, binding with high affinity to muscarinic receptors of M1-, M2- and M3-subtypes, and dissociating very slowly from M1- and M3-receptors but more rapidly from M2-receptors 4.
- Tiotropium is generally well tolerated, with the most common adverse event being dry mouth, which is reversible and rarely causes discontinuation of therapy 3, 4, 5, 6, 7.
Clinical Efficacy
- Clinical trials have demonstrated that tiotropium is more effective than placebo in improving lung function and reducing symptoms in patients with COPD 3, 4, 5, 6, 7.
- Tiotropium has been shown to be at least as effective as salmeterol and more effective than ipratropium in improving lung function and reducing exacerbations 4, 6, 7.
- The once-daily dosing of tiotropium increases the likelihood of patient compliance, making it a valuable option for the treatment of patients with COPD 4, 7.
Mechanism of Action
- Tiotropium acts as an anticholinergic bronchodilator, antagonizing the muscarinic M1, M2, and M3 receptors located in airway smooth muscle, reversing vagally mediated bronchoconstriction 6.
- It has a quaternary ammonium structure and is kinetically selective for M1 and M3 receptors over the M2 receptor, unlike ipratropium bromide, which is nonselective 4, 6.