What is the purpose of the Stilolto (tiotropium and olodaterol) inhaler?

From the Guidelines

Stilolto Inhaler is a recommended maintenance medication for chronic obstructive pulmonary disease (COPD) as it combines a long-acting beta-agonist (LABA) and a long-acting muscarinic antagonist (LAMA), which has been shown to improve lung function, dyspnea, and health status, and reduce exacerbation rates 1. The Stilolto Inhaler contains indacaterol (a LABA) and glycopyrronium (a LAMA), with a standard dosage of one inhalation once daily, delivering 85 micrograms of indacaterol and 43 micrograms of glycopyrronium. Key benefits of this combination include:

• Improved lung function and symptoms
• Reduced exacerbation rates
• Enhanced health status
• Decreased hospitalizations due to COPD exacerbations, as LAMAs have a greater effect on exacerbation reduction compared to LABAs 1. When using Stilolto, patients should:
• Inhale at the same time each day to maintain consistent drug levels
• Rinse their mouth afterward to prevent thrush
• Not stop using it without medical advice, even if symptoms improve Common side effects may include dry mouth, throat irritation, and potential heart palpitations. It is essential to note that Stilolto is not for acute breathing problems (rescue therapy) but rather for long-term COPD management, so patients should still keep rescue inhalers available for sudden symptoms. The combination of LABA and LAMA in Stilolto has been shown to be superior to monotherapy, with improvements in FEV1, symptoms, and exacerbation rates 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 Stilolto inhaler is used for the long-term, once-daily maintenance treatment of patients with chronic obstructive pulmonary disease (COPD). It is not indicated for the treatment of acute deterioration of COPD or asthma 2.

From the Research

Stilolto Inhaler Overview

• The Stilolto inhaler, also known as Spiolto, is a fixed-dose combination of tiotropium and olodaterol, delivered via the Respimat Soft Mist inhaler 3.
• It is indicated for the maintenance treatment of airflow obstruction in adults with chronic obstructive pulmonary disease (COPD) 3.

Efficacy and Safety

• Tiotropium/olodaterol maintenance therapy has been shown to improve lung function, health-related quality of life, and dyspnea in patients with COPD 3, 4.
• The combination therapy has also been found to improve inspiratory capacity and exercise endurance in patients with COPD 3.
• The tolerability profile of tiotropium/olodaterol is generally similar to that of the component monotherapies, with the most common adverse events being respiratory in nature 3.

Disease Severity and Treatment History

• Post hoc analyses of the OTEMTO studies found that tiotropium/olodaterol improved lung function and quality of life in patients with moderate to severe COPD, regardless of disease severity or treatment history 4.
• The benefits of tiotropium/olodaterol were most evident in the GOLD B subgroup, and lung function outcomes were generally greater in patients who had received previous long-acting bronchodilator and/or inhaled corticosteroid (ICS) maintenance treatment 4.

Reducing Exacerbations

• The use of tiotropium/olodaterol as initial and follow-up treatment in patients with COPD has been found to reduce the risk of exacerbations and improve lung function and quality of life 5.
• A study found that tiotropium/olodaterol was associated with a lower risk of COPD exacerbations, pneumonia, and escalation to triple therapy compared to LABA/ICS therapy 6.

Clinical Guidelines

• The American Thoracic Society recommends the use of long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) combination therapy, such as tiotropium/olodaterol, over LABA or LAMA monotherapy in patients with COPD and dyspnea or exercise intolerance 7.
• The guideline also conditionally recommends the use of triple therapy with ICS/LABA/LAMA over dual therapy with LABA/LAMA in patients with COPD and dyspnea or exercise intolerance who have experienced one or more exacerbations in the past year 7.