Tiotropium (Spiriva)

Tiotropium bromide inhalant powder a long-acting anticholinergic agent for a once-daily maintenance treatment of bronchospasm in chronic obstructive pulmonary disease.

Long acting anticholinergics suppress parasympathetic control.

Long-acting muscarinic antagonist.

The most commonly prescribed long acting anti-muscarinic agent.

Inhibits bronchorestrictive and secretory effects of acetylcholine.

Produces greater improvement in lung function than placebo or ipratropium in one-year trials.

Not indicated for acute bronchospasm..

As an anticholinergic agent may worsen narrow-angle glaucoma or bladder neck obstruction.

Administered as a capsule containing powder inhaled once daily using a hand held inhalation device which pierces the capsule and disperses the drug into the air stream.

Most common side effect is dry mouth.

Other reactions include tachycardia, blurred vision and constipation.

May be combined with other drugs used in COPD without increasing adverse reactions.

Coadministration with other anticholinergic is not recommended.

One year trials compared to ipratropium in patients with COPD resulted in improved FEV1 levels by 150 mL.

In patients with COPD treated in a randomized double blind control trial comparing 4 years of treatment with tiotropium or placebo revealed improvements in pulmonary function, quality of life, and reduced exacerbations but did not significantly reduce rate of decline in FEV1 (Understanding Potential Long Term Impacts on Function with Tiotropium-UPLIFT trial).

Tiotropium delivered by the handheld device, the first long-acting anticholinergic bronchodilator for treatment of COPD.

Demonstrates sustained bronchodilation over a 24-hour period.

Treatment with the tiotropium HandiHaler reduces COPD exacerbations.

Tiotropium is associated with a greater reduction in the risk of exacerbations than salmeterol (Quanjer PH et al).

Tiotropium is delivered by the handheld device, the first long-acting anticholinergic bronchodilator for treatment of COPD. or will

Pooled data from 29 placebo-controlled tiotropium trials demonstrate an increase in the rate of stroke.

Meta-analysis of 17 randomized clinical trials evaluating the cardiovascular risk associated with inhaled anticholinergic agents there was a relative risk of cardiovascular events of 1.60 for inhaled anticholinergics as compared with a combination of placebo and active controls(Singh S et al).

The use of inhaled anticholinergics is associated with a significantly increased risk of major adverse cardiovascular events, including death from cardiovascular causes, myocardial infarction, and stroke.

When newly added to long acting beta agonist and inhaled corticosteroids combination therapy is associated with increased cardiovascular risks in patients with COPD.

Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) trial did not show an increased risk of myocardial infarction, death from cardiovascular causes, or death from any cause in its comparison of tiotropium HandiHaler with placebo (Tashkin DP et al).

In a one year randomized double-blind study comparing a tiotropium 18 mcg once daily compared with salmeterol 50 mcg twice-daily on the incidence of moderate or severe exacerbations in patients with moderate to very severe COPD: tiotropium was more effective than salmeterol (Vogelmeier C et al).

In a three way double-blind study of 210 patients with asthma the addition of tiotropium bromide, a long-acting anti-cholinergic agent, was added to an inhaled glucocorticoid, as compared with doubling of the dose of the inhaled glucocorticoid or the addition of the long acting beta agonist salmeterol: the addition of tiotropium two inhaled glucocorticoids improves symptoms and lung function in patients with inadequately controlled asthma and its effects appear to be equivalent to those with the addition of salmeterol (Peters SP et al).

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