Woman taking Spiriva through inhaler

Spiriva, a long-acting bronchodilator, is the brand-name for tiotropium bromide, which is used as part of maintenance treatment for chronic obstructive pulmonary disease (COPD) and asthma.

Asthma and COPD are not only the most widespread chronic respiratory diseases, but they are also among the top 20 causes of global disability. However, it is quite difficult to accurately measure the prevalence, burden and mortality rates of both the diseases because they are often misclassified due to a lack of consensus on their case definitions.[1]

Another factor that makes differentiating between the two diseases difficult is that they produce similar effects. Both asthma and COPD can cause:

  • Chest tightness
  • Shortness of breath
  • Coughing
  • Wheezing

However, there are also some signs and effects that can help differentiate between the two respiratory diseases.

How to Differentiate Between Asthma and COPD

Here are a few factors that can help differentiate between the two diseases of the respiratory system:

  • Asthma is not specific to any age group, whereas COPD generally occurs in people over 40 years of age; there can be some exceptions though.
  • In asthma, patients usually experience periods of exacerbation followed by periods of normal breathing, whereas patients of COPD do not experience periods of relief; their breathing does not generally return to normal.
  • Chronic cough is more common among COPD patients.
  • COPD causes more mucus and phlegm production than asthma.
  • Lips and/or fingernail beds of COPD patients often turn blue, a condition known as cyanosis.

Treatment of Asthma and COPD

Asthma and COPD, the chronic diseases of the respiratory tract, are not curable, in the very sense of the term. However, they are eminently controllable due to medical advancements.

A treatment and management plan for asthma and COPD generally involves using a combination of bronchodilators (short and long acting) along with making certain lifestyle changes, such as stopping smoking. Sometimes, patients are recommended to take vaccinations for preventing lower respiratory tract infections.

[1] https://www.pulmonologyadvisor.com/home/topics/asthma/asthma-and-copd-updates-on-prevalence-disability-and-mortality/

How Spiriva Helps With Asthma and COPD

Spiriva is a long-acting bronchodilator that belongs to the class of drugs called anticholinergics; a broad category of medicines that block the action of acetylcholine.

Acetylcholine is a neurotransmitter that controls the contraction of muscles and pain responses and is responsible for the regulation of endocrine functions and REM (rapid eye movement) sleep. Blocking of this neurotransmitter affects various body functions by inhibiting involuntary muscle movements in different parts of the body, such as the urinary tract, gastrointestinal tract, and the lungs.

Since anticholinergic medicines can have wide-ranging effects, they are used to treat several health conditions. Only a qualified healthcare practitioner can determine the right type, dosage, and the duration of use of anticholinergic medicine for asthma and/or COPD patients.

In patients of asthma and COPD, Spiriva helps to prevent or reduce the risk of bronchospasm by causing the muscles surrounding the airways to relax. As a result, the airflow to the lungs increases, enabling the patients to breathe easily.

Is Spiriva a Rescue Medicine?

No, Spiriva is not a rescue medicine and should not be used the treatment of acute bronchospasm during flare-ups.


Spiriva is available in the following two different forms:

  1. Spiriva Respimat, an inhalation spray that is available in two dosage strengths. An actuation of Spiriva Respimat delivers 1.25 mcg or 2.5 mcg of tiotropium.
  2. Spiriva HandiHaler, which is an inhalation powder that comes in the form of capsules and is used with a HandiHaler device.

The active ingredient in both forms of Spiriva is tiotropium bromide, an anticholinergic agent.


The Spiriva Respimat inhalation spray should not be used for children under 6 years of age. Spiriva HandiHaler capsules are not meant to be taken by mouth – they should only be used in the HandiHaler device.

Storage Considerations

Store both Spiriva inhaler and capsules at room temperature away from heat and moisture. Do not store the capsules in a HandiHaler device.

Do not freeze the Spiriva inhaler and discard it after 3 months of first use or when the inhaler gets locked (happens after 60 puffs i.e. 30 doses), whichever comes first.

Recommended Dosage of Spiriva

While it may vary across patients, here are the most generally prescribed dosages of Spiriva:

Spiriva Respimat

Asthma patients are generally prescribed 2 inhalations of 1.25 mcg/ actuation Spiriva Respimat, once daily.

On the other hand, the general recommended dosage for people suffering from COPD is 2 inhalations of 2.5mcg/ actuation Spiriva Respimat, once daily.

Spiriva HandiHaler

Two inhalations of Spiriva powder to be taken with the HandiHaler device, once a day, is the recommended dosage for both asthma and COPD patients.

Important: Do not take more than two inhalations and one dose in 24 hours.

Things to Consider Before Taking Spiriva

To ensure the safety of this anticholinergic drug, make sure to tell your doctor if you have or have ever had any of the following health conditions:

  • Kidney disease
  • Enlarged prostate
  • Urination problems
  • Narrow-angle glaucoma
  • Milk allergy

While the effects of tiotropium bromide on the fetus are not known, uncontrolled asthma pregnancy can cause certain complications during pregnancy, such as extremely high blood pressure that can be dangerous for both the mother and the baby. It can also result in premature birth and low birth weight. Hence, it is highly important that women suffering from asthma or COPD tell their doctor if they are or planning to get pregnant.

The use of Spiriva may also not be safe while breastfeeding, so it is highly important to tell your doctor if you are a nursing mother or plan to breastfeed and discuss the potential risks.

Possible Side Effects of Spiriva

Just like all other medications, Spiriva can also cause some negative effects. Some common side effects of Spiriva include:

  • Dry mouth
  • Upset stomach
  • Painful urination
  • Symptoms of cold, such as sore throat, sinus pain, and runny or stuffy nose
  • Blurred vision
  • Nausea
  • Sweating
  • Pain in jaw, arms, or back
  • Irregular or fast heartbeat
  • Discomfort, tightness, heaviness, or pain in the chest

Serious Side Effects of Spiriva

Consult your doctor immediately if you experience any of the following effects with Spiriva:

  • Blurred vision with redness or eye pain and/or seeing halos around lights
  • White patches or sores on the mouth, tongue, and/or lips
  • Breathing problems, like wheezing and choking, after using Spiriva
  • Burning or pain while urinating
  • Reduced or no urination

While many of the negative effects of Spiriva do not need medical attention and they go away as your body adjusts to the medicine, some may need dosage adjustments or change of medicine. Consult your doctor if any of the following side effects do not go away after a few days of beginning the treatment with Spiriva or become severe with time:

  • Cloudy or bloody urine
  • Bladder pain
  • Frequent urge for urination
  • Difficult or painful urination
  • Chest pain
  • Aches or pain in the body
  • Belching; gas and bloating, and/or indigestion
  • Dyspepsia
  • Severe cough
  • Congestion
  • Dryness in the mouth and/or throat
  • Chills
  • Discomfort or pain in the stomach
  • Heartburn
  • Sneezing
  • Hoarseness or loss of voice
  • Tenderness or pain around cheekbones and eyes
  • Tenderness or swelling of glands in the neck
  • Fever

Spiriva Drug Interactions

Although it is recommended that you tell your doctor about all the medicines that you are taking whether they are prescription, non-prescription, herbal, or dietary supplements, before starting your treatment with Spiriva, make sure your doctor knows if you are taking medicines for any of the following health conditions, in particular:

  • Anxiety or depression
  • Mood disorders
  • Mental illnesses
  • Parkinson’s disease
  • Stomach problems, such as irritable bowel syndrome
  • Motion sickness
  • Overactive bladder
  • Allergy or cold

Also, tell your doctor if you are already taking any medicine for asthma or COPD. Spiriva should not be co-administered with any other anticholinergic drug as it may worsen the negative effects.

Warnings and Precautions

Stop taking Spiriva at once and consult your doctor if the drug causes immediate hypersensitivity reactions, such as itching, rash, bronchospasm, hives, angioedema, or anaphylaxis (a severe allergic reaction that could be fatal).

The medicine should also be discontinued if it causes paradoxical bronchospasm i.e. worsening of symptoms, such as wheezing and difficulty in breathing.

Spiriva should be used with caution in patients having the following health issues as it may worsen them:

  • Urinary retention
  • Narrow-angle glaucoma
  • Renal impairment

Prescription Assistance for Spiriva

Spiriva is an expensive drug – the average cost of a pack of 5 Spiriva capsules is around $97, whereas the cost of Spiriva inhaler is around $457. The high cost of the medicine has made it inaccessible to a large number of patients.

In view of the problems faced by many patients in getting access to Spiriva because of their poor financial conditions, Boehringer Ingelheim (the company that manufactures the drug) has incorporated it into its Patient Assistance Program.

The BI Cares Patient Assistance Program is a charitable program run by the Boehringer Ingelheim Cares Foundation – a private non-profit organization that is dedicated to improving the health and lives of patients by making Boehringer Ingelheim medicines accessible for them.

Under the BI Cares Patient Assistance Program, many Boehringer Ingelheim medicines are provided free of cost to the eligible uninsured or underinsured US citizens.

Click here to check the eligibility criteria and to fill out the application form or call 1-800-556-8317, Monday to Friday from 8:30 am to 6 pm Eastern time, for further assistance.

Boehringer Ingelheim also runs several other social welfare programs, such as skill-based volunteering, product donation program and financial contributions program, to help patients across the world, strengthen communities, and to promote the culture of helping each other. Visit the company’s website to learn more about the various support programs it runs.