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Spiriva Handihaler / Respimat Inhaler for COPD and Asthma

What is COPD?

The strict definition of COPD is a breathing condition characterized by airflow limitation—that’s having trouble with the flow of air in and out of the lungs. Subtypes of COPD are emphysema, chronic bronchitis and chronic obstructive asthma.  

What’s the first-line treatment for COPD?

The initial management of your symptoms will include using the “as needed” bronchodilator, albuterol (Proair, Ventolin, Proventil). When your symptoms are no longer controllable with albuterol alone, then it starts to get expensive with brand-name maintenance inhalers like Spiriva. You and your doctor will often be fighting for insurance coverage of those inhalers.

After that, if you are still having COPD symptoms, adding a third inhaler like Advair—or another long-acting beta-agonist (LABA) and steroid combination drug like Symbicort—is your likely next step.

What is Spiriva?

Spiriva (tiotropium) is a long-acting anticholinergic medication that opens up the airways. Spiriva is available as Spiriva Handihaler and Spiriva Respimat Inhaler. Spiriva Handihaler is the dry powder preparation that comes in a capsule inhaler device dosed at 18 mcg once daily. Spiriva Respimat Inhaler is a soft mist inhaler administered as two inhalations of 2.5 mcg (5 mcg total) once daily.

Once daily Spiriva results in improved breathing and quality of life as well as fewer episodes of COPD exacerbations (flare-ups of worsening symptoms).

Is Spiriva a steroid?

Spiriva is NOT a steroid. Spiriva acts on chemical receptors in the airways to relax the muscles and increase airflow. It’s also NOT to be used as a rescue inhaler; that’s what your albuterol is for.

Is Spiriva safe to use long term?

Yes. Several long-term studies observing Spiriva use over four years have not identified any safety issues.

Is Spiriva better than Atrovent?

Yes. Spiriva is longer acting than Atrovent HFA (ipratropium), another maintenance bronchodilator. In studies, using Spiriva resulted in better airway dilation and less inhaler (albuterol) use than using Atrovent.

Is Spiriva better than Serevent?

Yes. Once daily Spiriva has been compared in studies to Serevent (salmeterol), which is also a long-acting bronchodilator. Spiriva is better at opening up the airways and improving shortness of breath than Serevent.  

Dr O.

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