Tiotropium inhaler (Spiriva): uses, side effects and cautions

Tiotropium is used to prevent the cough, wheeze and breathlessness of chronic obstructive pulmonary disease (COPD) and, in some people, asthma. It is a maintenance treatment taken daily, not a rescue inhaler, so people with COPD or asthma are normally also given a reliever such as salbutamol.

Some inhalers combine tiotropium with olodaterol, a long-acting beta agonist. Those have their own leaflets, but the cautions below about eyes, bladder and heart are broadly relevant.

The NHS describes tiotropium as an anticholinergic bronchodilator. Nerves that trigger muscle tightening in the airways use a chemical messenger, and tiotropium blocks the receptors that respond to it, so the muscle relaxes and the tubes widen. Its effect is slowly released across the day, which is why one dose every 24 hours is enough.

Other medicines in the same family include glycopyrronium and umeclidinium. Long-acting beta agonists such as formoterol and salmeterol, and steroid inhalers such as beclometasone and fluticasone, can be used in different combinations alongside it.

The NHS lists two device types. Capsule inhalers, such as the HandiHaler used with Spiriva capsules and the Zonda used with Braltus capsules, need a fresh capsule each time; you pierce it with the button, then breathe in twice from the mouthpiece so the capsule is emptied. Keep capsules in their bottle or blister pack, never inside the device, and check the mouthpiece is clear first.

Cartridge inhalers, including Spiriva Respimat, hold several doses so you do not load something each time. Read the leaflet for priming and loading. Unlike steroid inhalers, you do not need to rinse your mouth afterwards. If the brand you are given changes, the number of puffs may change too, but it is still used once daily.

The NHS gives the usual dose as 1 or 2 puffs once a day, and you will normally stay on the same dose. Ask a pharmacist, nurse or doctor to watch your technique if it has not been checked in a year.

If you forget a dose, take it as soon as you remember unless you do not realise until the next day, in which case skip it and carry on as usual. Do not double up. Taking too much can cause dry mouth, a faster heartbeat and blurred vision, and the NHS advises calling 111 if you have a faster heartbeat or blurred vision after using more than prescribed.

With inhalation very little drug reaches the rest of the body, so side effects are usually limited. More than 1 in 100 people get a dry mouth. The NHS advises contacting a doctor or 111 straight away for difficulty sleeping, blurred vision, red eyes or rings around lights, which can signal glaucoma, difficulty passing urine, a faster or noticeable heartbeat and difficulty swallowing.

A sudden swelling of the lips, mouth, throat or tongue can be a serious allergic reaction and needs 999. Report suspected side effects through the Yellow Card scheme.

Most adults and children aged 6 and over can use tiotropium. Tell your prescriber first if you have had an allergic reaction to tiotropium or another medicine, if you have glaucoma, prostate problems or difficulty passing urine, if you had a heart attack in the last 6 months, or if you have an irregular heartbeat or heart failure.

The NHS says other common asthma and COPD treatments are unlikely to interact with tiotropium, but some medicines can raise the chance of side effects, so check with a pharmacist before starting anything new, including herbal remedies.

The NHS says tiotropium can be used in pregnancy, though you should tell your doctor if you become pregnant so treatment can be reviewed, and that it is fine while breastfeeding, including the versions with olodaterol, because tiny amounts are thought to reach milk. It does not affect contraception.

It rarely affects driving or cycling, but do not do either if your eyesight is affected or you feel dizzy. Alcohol and normal food and drink are fine. Do not stop without speaking to your doctor: wheeze, a tight chest and cough may return. Most people use it for a long time, sometimes many years, and the NHS says there is no evidence of lasting harm.