Tiotropium & Combinations

What are the medications in Spiriva Respimat, and what type of inhaler device is it?

Tiotropium in a soft-mist inhaler.

What are the medications in Spiolto Respimat, and what type of inhaler device is it?

Tiotropium and olodaterol in a soft-mist inhaler.

What are some common indications for Spiriva Respimat?

COPD and asthma

What are some common indications for Spiolto Respimat?

COPD

How would you explain the mechanism of action of tiotropium to a patient?

Tiotropium helps keep your airways open by blocking signals in your body that cause the muscles around your airways to tighten. This relaxes those muscles, making it easier for air to move in and out of your lungs and helping you breathe more comfortably. This can reduce breathlessness and improve airflow in conditions such as COPD and asthma. One dose will provide effects for the whole day, and using it regularly can reduce the risk of exacerbations and hospital admissions in COPD.

How would you explain the mechanism of action of tiotropium and olodaterol in combination to a patient?

This inhaler contains two medicines that work in different ways to help open up your airways. Tiotropium blocks the signals that tighten the muscles around your airways, while olodaterol stimulates receptors that help those muscles relax. Together, they help keep your airways open for longer, making breathing easier and reducing breathlessness.One dose will provide effects for the whole day, and using it regularly can reduce the risk of exacerbations and hospital admissions in COPD.

What is the usual dose of Spiriva Respimat?

2 inhalations once daily. Each inhalation contains 2.5mcg tiotropium.

What is the usual dose of Spiolto Respimat?

2 inhalations once daily. Each inhalation contains 2.5mcg tiotropium and 2.5mcg olodaterol.

What are some important precautions for tiotropium?

• Cardiovascular disease: May increase risk of cardiovascular events

• Acute-closure glaucoma: May rarely precipitate acute-closure crisis, especially with soft-mist formulations

• Bladder outlet obstruction: May worsen urinary retention

• Renal impairment: Renally cleared, may increase risk of side effects if CrCl <50

What are some important side effects associated with tiotropium?

• Dry mouth, throat irritation

• Blurred vision, dizziness

• Urinary retention

• Rarely causes acute-closure crisis

What are some important referral points for tiotropium?

• Eye pain or discomfort

• Blurred vision

• Visual haloes

• Difficulty urinating

What are some important counselling points for tiotropium?

• Do not allow the mist to come into contact with your eyes.

• Do not drive or operate machinery until you know how this medicine affects you, as it can cause dizziness or affect your vision.

• Do not use for immediate relief of symptoms.

• Use this medicine every day, even if you start feeling better.

What are some important side effects associated with olodaterol?

• Tremor

• Palpitations or tachycardia

• Headache

What are some important counselling points for olodaterol?

• Use this medicine every day, even if you start feeling better.

• Do not use for immediate relief of symptoms.

How would you counsel a patient to prime a Respimat inhaler?

1. Remove the clear base by pressing the safety catch while pulling off the clear base with your other hand. Keep the cap closed.

2. Insert the cartridge into the inhaler, place the inhaler on a firm surface and push down firmly until it clicks into place.

3. Mark the checkbox on the inhaler’s label to track the number of cartridges used.

4. Put the clear base back into place until it clicks.

5. Keep the cap closed and turn the clear base in the direction of the arrows on the label until it clicks (half a turn).

6. Open the cap until it snaps fully open.

7. To prime the inhaler, point the inhaler towards the ground and press the dose-release button. Close the cap.

8. Repeat steps 5-7 until a mist appears, then another three times. The inhaler is now ready for use.

9. Repeat step 7 if the inhaler has not been used for more than 7 days, and step 8 if it has been more than 21 days.

How would you counsel a patient on taking their daily doses of a Respimat inhaler?

1. Turn the clear base in the direction of the arrows until you hear a click.

2. Open the cap until it snaps fully open.

3. Breathe out slowly and fully.

4. Close your lips around the mouthpiece without covering the air vents. Point the inhaler to the back of the throat.

5. While taking a slow, deep breath through your mouth, press the dose-release button and continue to breathe in slowly for as long as comfortable.

6. Repeat the above steps for a total of two puffs daily.

7. Close the cap until you use your inhaler again.

How would you counsel a patient on replacing their Respimat inhaler and cartridges?

1. A pack contains a reusable inhaler device and a cartridge containing the medication.

2. Check the dose counter regularly to see how many puffs are left in the cartridge. If it turns yellow, there are less than 10 puffs remaining, and you should obtain a new cartridge. If it turns red, there are no doses left, and the cartridge needs to be replaced.

3. To remove the used cartridge, turn the clear base to loosen it and pull the cartridge off the inhaler. The new inhaler will stick out more than the very first cartridge did.

4. Keep track of how many cartridges you have used with the reusable inhaler using the checkboxes. Once you have used six cartridges with an inhaler, you should obtain a new reusable inhaler. Do not use a reusable inhaler for more than 1 year after inserting the first cartridge.

How would you counsel a patient on caring for and cleaning their Respimat inhaler?

Clean the mouthpiece, including the metal part inside, with a damp cloth or tissue. This should be done at least once per week. If necessary, also wipe the outside of your inhaler with a damp cloth.