Do I Really Need Spiriva for My COPD?

Chronic obstructive pulmonary disease (COPD) is a common condition that affects more than 15 million adults in the U.S. It’s also the fourth-leading cause of death in the country. 

There are several inhalers and other medications that treat the condition. One of those is Spiriva (tiotropium),, a once-daily inhaled prescription medication that is FDA-approved to treat COPD.

What is Spiriva?

Spiriva is a long-acting, inhaled anticholinergic medication that opens up the airways. Spiriva is available as the Spiriva HandiHaler (tiotropium bromide capsule) and the Spiriva Respimat Inhaler (tiotropium bromide inhalation spray). The Spiriva HandiHaler is a dry powder preparation that’s used in a capsule-based inhaler. The dosage is 2 inhalations of a single 18 mcg capsule once daily. The Spiriva Respimat Inhaler is a soft mist inhaler administered as 2inhalations of 2.5 mcg (5 mcg total) once daily.

Spiriva Respimat Inhaler vs. Spiriva HandiHaler

As mentioned above, Spiriva Respimat and Spiriva HandiHaler are two different types of Spiriva inhalers. While the inhalers are quite different, they both about the same in terms of safety and effectiveness.

The Spiriva HandiHaler was the first of the two inhaler forms to come on the market and was approved by the FDA in 2004 With the HandiHaler, you take a capsule of powdered medication and place it into the inhaler chamber. Then, you press a button on the side of the inhaler to pierce the capsule and you breathe in the medication. You do not swallow the capsule. 

The Spiriva Respimat Inhaler was approved by the FDA in 2014. The medication used with the Respimat Inhaler is a fine mist, kind of like what you would use with a nebulizer. You twist the inhaler to load the dose, then remove the cap, and inhale while pressing a button that delivers the medication. The Respimat Inhaler is also approved to treat asthma in people ages 6 and older, whereas the HandiHaler is just approved for the treatment of COPD.

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Another difference between these two versions of Spiriva is the inhaler device in which they are supplied. The research shows that they work about the same to help with COPD, so choosing between them may come down to which one you’re most comfortable with . If you’re using the Spiriva HandiHaler or the Spiriva Respimat Inhaler, make sure to check with your healthcare provider or pharmacist on how to administer the medication properly.

How does Spiriva help COPD?

Spiriva works to relax the airways and make it easier to breathe for people who have COPD. It targets muscarinic receptors in the airways and lowers the action of the neurotransmitter acetylcholine, which regulates muscle contraction and other bodily functions, at these receptors. In addition to relaxing muscles in the airways, it helps lower the amount of mucus, or secretions, in the lungs.

Is Spiriva a steroid?

No, Spiriva is not a steroid. Spiriva is a long-acting anticholinergic medication. It’s also referred to as a long-acting muscarinic antagonist (LAMA) medication. 

It acts on chemical receptors (binding sites) in the airways to relax the muscles and increase airflow. This is different from how steroid medications work. Though, inhaled corticosteroids are commonly used to treat asthma and COPD. 

What does Spiriva do for your lungs?

Research shows that Spiriva and other inhaled anticholinergic medications can have many benefits for people with COPD.

Some of these benefits include:

• Improvement in COPD symptoms

• Better health status in general

• More effective pulmonary rehabilitation efforts

• Less exacerbations

• Fewer hospitalizations

What are the side effects of Spiriva?

Like with all medications, Spiriva can cause side effects. Common side effects include:

• Cough

• Dry mouth

• Sore throat

• Sinus problems

• Dizziness

• Headache

• Fever

• Runny nose

Although rare, Spiriva can also cause serious side effects. Severe allergic reactions (anaphylaxis), trouble urinating, and worsened glaucoma have been reported with the medication. 

Another serious side effect is a paradoxical bronchospasm, which causes difficulty breathing or a sudden worsening of wheezing. If this happens, you should use a rescue inhaler like albuterol (Ventolin, ProAir, Proventil). And, if the symptoms continue or get worse, you should seek emergency medical care.

Is Spiriva safe to use long term?

Yes, Spiriva is meant to be used as a daily, long-term maintenance inhaler. In one study that observed patients with COPD for 4 years, Spiriva improved overall lung function. 

Is Spiriva better than Atrovent?

Spiriva is longer-acting than Atrovent (ipratropium), another daily inhaler approved to treat COPD. Because it’s short-acting, Atrovent usually needs to be taken 4 times a day. In a review of studies comparing both medications, taking Spiriva resulted in better lung function, less hospitalizations, less exacerbations, and better quality of life.

Is Spiriva better than Serevent?

Once-daily Spiriva has been compared to Serevent (salmeterol), which is also a long-acting inhaler medication. One study found that Spiriva was more effective than Severent at preventing exacerbations in people with moderate to severe COPD. 

Is Spiriva better than Symbicort?

Symbicort (budesonide/formoterol) is a combination medication. In one study, participants starting treatment with an inhaler for COPD had better health improvements from taking Symbicort than from taking Spiriva. But, since these two inhalers work in different ways, they can be combined to treat COPD if your symptoms aren’t well controlled, which is sometimes called step-up treatment.

What’s the first-choice treatment for COPD?

Spiriva may be a first-choice treatment for your COPD , depending on your symptoms and your health history. Your healthcare provider can help you determine the best treatment to start with. 

Once you begin treatment, your healthcare provider will also help monitor how well the medication is working. If your symptoms are getting worse, you may need a higher dose or different medication to manage your condition.

How to save on Spiriva

There are ways to save on Spiriva, which is available as a brand-name and generic medication. GoodRx can help you navigate between GoodRx coupons, copay savings cards, and patient assistance programs to save money on your prescription.

• Save with GoodRx: Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase a 30-day supply of generic tiotropium at an exclusive cash price, which ranges from $75 to $365 — prices vary by pharmacy.

• Save with a copay savings card: If you have commercial insurance, you may be eligible to pay as little as $35 for Spiriva HandiHaler or Sprivia Respimat using a savings card from the manufacturer. A $25 savings card is available for the generic version of Spiriva HandiHaler, too.

• Save with patient assistance programs: If you’re uninsured or underinsured, you may be eligible for Spiriva’s patient assistance program, which offers the medication free of charge.

Why trust our experts?

Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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