ADIS DRUG CLINICAL Q&A Tiotropium Respimat Soft Mist inhaler: a guide to its use in chronic obstructive pulmonary disease (COPD) in the EU

Tiotropium Respimat Soft Mist inhaler (Spiriva Respimat ) is indicated as a maintenance bronchodilator to relieve the symptoms of patients with chronic obstructive pulmonary disease (COPD) in the EU. The delivered drug dose is independent of inspiratory effort and the prolonged duration of the aerosol cloud should make the co-ordination of actuation and inhalation easier. In patients with COPD, tiotropium Respimat improved lung function, COPD exacerbations, health-related quality of life and dyspnoea, and was generally well tolerated. Relative to administration of tiotropium via the HandiHaler , administration of the drug via the Respimat Soft Mist inhaler improves lung deposition of the drug (allowing a lower nominal dose to be used), is at least as effective, and has a similar tolerability profile. Adis evaluation of tiotropium Respimat Soft Mist inhaler in chronic obstructive pulmonary disease Improves lung function, disease exacerbations, health-related quality of life and dyspnoea Inspiratory effort does not affect the dose of the drug delivered by the inhaler Prolonged duration of the aerosol cloud should make the coordination of actuation and inhalation easier Generally well tolerated Is at least as effective and well tolerated as tiotropium HandiHaler What is the rationale for using tiotropium bromide in COPD? Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation [1]. Bronchodilators are central to the symptomatic management of COPD, with long-acting bronchodilators generally preferred over shortacting bronchodilators and inhaled therapy generally preferred over oral therapy [1]. In the EU, inhaled long-acting bronchodilators include anticholinergics that are administered once daily (e.g. tiotropium bromide, glycopyrronium bromide and umeclidinium bromide) or twice daily (e.g. aclidinium bromide), and long-acting b2-agonists that are administered once daily [e.g. indacaterol, olodaterol and vilanterol (latter is not available as monotherapy)] or twice daily [e.g. formoterol and salmeterol (given in combination with inhaled corticosteroids)] [1, 2]. Anticholinergic agents represent a rational approach to the management of COPD, as muscarinic M1, M2 and M3 receptors are found in human airways, with M3 receptors mediating bronchoconstriction and mucus secretion [3]. Tiotropium bromide binds with high affinity to M1, M2 and M3 receptors in the human airways [3]. The competitive and reversible inhibition of M3 receptors by tiotropium bromide results in relaxation of the bronchial smooth muscle [4]. Inhaled tiotropium bromide is topically selective, with its rapid (within 30 min) and prolonged (lasting for 24 h) bronchodilation resulting from local airway, rather than systemic, effects [5, 6]. There is a large body of data supporting the efficacy of tiotropium bromide administered via the dry-powder HandiHaler (Spiriva HandiHaler ) in patients with COPD [6]. This review focuses on the use of the more recently developed formulation of tiotropium bromide solution for inhalation administered via the Respimat Soft K. A. Lyseng-Williamson (&) G. M. Keating Springer, Private Bag 65901, Mairangi Bay, North Shore 0754, Auckland, New Zealand e-mail: [email protected] Drugs Ther Perspect DOI 10.1007/s40267-014-0181-x