Tiotropium (Spiriva) 💊

Always check the BNF link here for up-to-date prescribing advice.

• 💨 Long-acting bronchodilator, mainly used in COPD.
• Anticholinergics (LAMA – long-acting muscarinic antagonists) are first-line bronchodilators in COPD maintenance.

⚙️ Mechanism of Action

• Blocks muscarinic M3 receptors on airway smooth muscle → sustained bronchodilation.
• Onset: 30–60 minutes ⏱️.
• Duration: up to 24 hours → once-daily dosing.
• More effective in COPD than asthma (though sometimes used as add-on in severe asthma).

🎯 Indications

• Once-daily maintenance therapy in COPD (improves symptoms, exercise tolerance, reduces exacerbations).
• Not suitable for acute bronchospasm 🚫 (slower onset than SABAs like salbutamol).

💊 Dose

• Administered by inhalation (metered-dose inhaler, dry-powder inhaler, or Respimat device).
• COPD maintenance: Tiotropium 18 micrograms OD inhaled (onset 30–60 min, duration 24 h).

⚠️ Cautions & Contraindications

• Glaucoma (risk of precipitating angle-closure if drug enters eye).
• Cardiac conditions: CCF, arrhythmias ❤️.
• Prostatic hypertrophy / urinary retention issues 💧.

⚠️ Side Effects

• Dry mouth, blurred vision 👁️, constipation.
• Urinary retention (especially in men with BPH).
• Dilated pupil / acute angle-closure glaucoma if inhaled drug gets into eyes.
• Paradoxical bronchospasm (rare but serious).
• Allergic reactions (rash, angioedema, urticaria).

📚 References

• BNF – Tiotropium
• GOLD COPD Guidelines.
• Oxford Handbook of Clinical Medicine.