Asthma is a chronic lung disease where the airways become inflamed and narrowed. When the airways react to certain inhaled substances, the muscles around the airways begin to tighten and restrict airflow to the lungs. If swelling occurs, the airways become even narrower. Mucous occurs, and symptoms include shortness of breath, chest tightness and coughing. More than 25 million people in the United States have asthma, and seven million are children. Many people with asthma are able to maintain good control with long-acting beta-agonists and inhaled corticosteroids. However, there are some who aren’t able to achieve good control with these therapies despite maximum dosages.
What is Spiriva?
Spiriva is an anticholinergic mediation that relaxes the smooth muscles in the lungs via a different mechanism than inhaled corticosteroids and long-acting beta-antagonists like Serevent. Spiriva inhalers have an active ingredient known as tiotropium. Specifically, this ingredient blocks the muscarinic receptors located on the muscles of the airways. Acetylcholine is the natural chemical that causes the airway muscles to narrow and contract, and tiotropium eliminates the action of acetylcholine. The muscles are then able to relax, and the airways are opened.
Spiriva is available in two types of inhalers. The Respimat inhaler uses a liquid form of the drug from a cartridge. The HandiHaler inhaler is a dry powder inhaler with capsules. The inhaler pierces the capsule, and the powder is breathed in. Both should be used once daily and last for approximately 24 hours to control asthmatic symptoms. Today, Spiriva is being used as a step-up therapy to regular inhalers and long-acting beta-antagonists.
Research and Clinical Studies on Spiriva
Many clinical studies have been done on the efficacy of Spiriva. Wake Forest researcher Dr. Stephen Peters and colleagues studied over 200 people with poorly controlled asthma. Participants were given 14 weeks of treatment with Serevent plus steroid inhaler and Spiriva plus steroid inhaler. The results indicated that Spiriva was more effective than just doubling the steroid inhaler dosage.
An NIH-funded study published in the New England Journal concluded that Spivira improved asthma symptoms and spirometry as an add-on therapy to inhaled corticosteroids. The NIH-funded study included over 900 adults with symptomatic asthma and continual airflow limitation while taking long-acting beta-agonists and inhaled corticosteroids. The participants were enrolled into two identical trials. Groups were divided into placebo and those who inhaled tiotropoium daily in addition to long-acting beta-agonists and inhaled corticosteroids. All dosages were stable throughout the trials. Every 24 weeks, peak and trough, symptoms and exacerbations were measured. Researchers found that only 27 percent of tiotropium users had exacerbation during the trial compared to 33 percent of the placebo group. The tiotropium group also had an exacerbation delay time of 282 days compared to 226 days of the placebo group. There was also an absolute reduction of severe exacerbations. Although the gains from this trial were small, Spiriva can definitely benefit thousands of people with refractory asthma.
The Safety of Spiriva
Spiriva has an established safety profile. The four-year Uplift study for adverse reactions, such as dry mouth, constipation, insomnia and pharyngitis, indicated a frequency less than 3 percent when compared to placebo groups. Adverse event data taken from over 26 clinical trials demonstrated the safety profile consistent with original registration trials. However, the use of Spiriva is contraindicated with those who have a history of hypersensitivity to ipratropium or tiotropium. Hypersensitivity reactions include rash, itching, angioedema and urticaria.
Spiriva needs to be used in caution with patients who have urinary retention problems and narrow-angle glaucoma. Since blurred vision and some dizziness can occur with the use of Spiriva, patients driving or operating machinery should be cautioned.
Before taking Spiriva, patients should advise their doctors of all existing medical conditions, such as kidney problems, glaucoma, enlarged prostate, pregnancy and allergies to milk proteins. Doctors should also be advised of any prescriptions and non-prescription drugs that you may be taking, including vitamins and eye drops. These medications may interfere with the way Spiriva works. In addition, no other anticholinergic medications should be used while on Spiriva.
Other Uses of Spiriva
Spiriva has been found helpful in the treatment of chronic obstructive pulmonary disease (COPD). COPD is a serious lung disease that usually includes emphysema and chronic bronchitis. Flare-ups include shortness of breath, mucus, cough and tightness in the chest. In a six-month study done at a veterans hospital by Boehringer Ingelheim Pharmaceuticals, Spivira reduced exacerbations in COPD patients by 27 percent. Spiriva is indicated for the long-term and maintenance treatment of COPD along with reducing COPD exacerbations.
