What to Know About Spiriva (Tiotropium Bromide)

A bronchodilator for the management COPD and asthma

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Spiriva (tiotropium bromide) is a long-acting bronchodilator that you might be prescribed for the management of your chronic obstructive pulmonary disease (COPD) or asthma. This medication is available in two formulations: Spiriva HandiHaler (tiotropium bromide inhalation powder) and Spiriva Respimat (tiotropium bromide inhalation spray), both of which are taken by inhalation.

Used once per day, Spiriva is approved for the prevention of everyday COPD and asthma symptoms and for the prevention of acute COPD or asthma exacerbations. This medication is not approved for the treatment of acute cases or exacerbations of dyspnea (shortness of breath).

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First approved by the U.S. Food and Drug Administration (FDA) in 2004, Spiriva is used to counteract the symptoms of bronchospasm, which is severe and/or sudden narrowing of the bronchi (airways) in the lungs. Symptoms of bronchospasm in asthma and COPD include shortness of breath, wheezing, and chest tightness.

This medication is an anticholinergic bronchodilator (also called a long-acting muscarinic antagonist or LAMA). It binds to cholinergic receptors on the muscles of the bronchi to oppose airway muscle contraction (which narrows the bronchi). Spiriva widens the airways, providing relief of symptoms and preventing exacerbations.

Both forms of Spiriva have similar indications, but Spiriva Respimat is approved for the treatment of asthma, while Spiriva HandiHaler is not.

Approved uses for Spiriva:

  • Spiriva HandiHaler: This medication is for the long-term maintenance treatment of bronchospasm associated with COPD and for reducing COPD exacerbations.
  • Spiriva Respimat: This medication is approved for the maintenance treatment of bronchospasm associated with COPD and for reducing COPD exacerbations. It's also approved for the long-term once-daily maintenance treatment of asthma in patients 12 years of age and older.

It's important to note that for people with moderate to severe COPD who also experience shortness of breath and/or exercise intolerance, Spiriva should be used along with a long-acting beta-agonist (LABA) rather than either of these medications alone.

Off-Label Uses

Spiriva HandiHaler has been used off label for maintenance treatment of asthma, and both formulations of tiotropium bromine have been used off label for the treatment of asthma exacerbation, COPD exacerbation, and for treatment of breathing difficulties associated with acute upper respiratory infections (without a diagnosis of asthma or COPD).

Before Taking

Spiriva can be used as a first-line agent in COPD treatment, and the inhalation spray version can be used as a first-line treatment for asthma. This means that it is not necessary to try other medications first before using Spiriva.

Spiriva can be used with other medications or on its own.

Precautions and Contraindications

You should not take this medication if you have ever had an adverse reaction to Atrovent (ipratropium) or any form of tiotropium bromide. It is also not recommended if you have hypersensitivity reactions to milk or milk proteins.

Its effect on pregnant women and babies of nursing mothers has not been studied, so this medication should only be used with extreme caution in these situations.

Spiriva can worsen the following conditions:

  • Glaucoma
  • Bladder problems or trouble passing urine
  • Kidney disease
  • Prostate problems

There are no generic versions of Spiriva. Atrovent (ipratropium bromide) is a similar anticholinergic medication taken with an inhaler or with a nebulizer.


The medication dose and inhaler device are specific to each formulation. Both forms of Spiriva are taken once daily.

Spiriva Respimat is available in 1.25-microgram (mcg) or 2.5-mcg strengths. Each dose requires two inhalations that, together, total 2.5 mcg (for asthma) or 5 mcg (for COPD).

Spiriva HandiHaler is prepared using capsules of dry powder-formulation titotropium, each of which contains 18 mcg of the drug. To deliver the full dose, two sprays are required.

Preparing the Medication

Spiriva needs to be prepared before you can inhale it. Do not swallow the medication directly.

Use your medication and the inhaler according to the package instructions. Each of these Spiriva formulations is prepared a little bit differently.

  • Spiriva Respimat: When you are using your inhaler for the first time, you need to insert your Spiriva Respimat cartridge into your inhaler. You have to prime it by spraying the inhaler toward the ground until an aerosol cloud is visible. Repeat this process three more times. If you don't use your inhaler for more than three days, you will need to prime it again by spraying once until an aerosol cloud is visible. And if you don't use your inhaler for more than 21 days, you need to prime it all over again by spraying the inhaler until an aerosol cloud is visible. Then repeat the process three more times to prepare the inhaler for use. 
  • Spiriva HandiHaler: When you are ready to use your medication, you should place a Spiriva capsule into the tiny slot in the center chamber of the HandiHaler device provided with your prescription. Then, close the white mouthpiece cover.

How to Take

After you properly prepare the medication, place the inhaler to your mouth and tightly seal your lips around the mouthpiece.

Breathe in quickly and deeply through the device as medication is dispensed. (You must press the green button on the side of the HandiHaler device as you inhale.) 

When using Spiriva HandiHaler, you should hear a rattling sound as you take a deep breath. This indicates the medication is being dispensed correctly from the capsule.

If you don’t, make sure the mouthpiece is tightly closed. Hold your HandiHaler upright and tap it gently on a hard surface. Try inhaling again. If you still don’t hear or feel the capsule rattle, talk to your healthcare provider or pharmacist as soon as possible.

Hold your breath for five to 10 seconds, and then breathe out normally. Rinse your mouth with water or brush your teeth after each use. Remove the medication from the device after each use and throw it away.

Be sure to clean your device according to the instructions when you're done.


Do not store medications in your inhaler ahead of time—place the medicine into the device before each use.

Spiriva Respimat and Spiriva HandiHaler should be stored at 77 degrees F and should not be exposed to extreme heat. Excursions with temperatures ranging between 59 degrees F to 86 degrees F are permitted.

Side Effects

The side effects for Spiriva Respimat and Spiriva HandiHaler are generally similar, although some people may be able to tolerate one of them better than the other.


There are a number of common side effects that don't cause serious harm but may be uncomfortable. If these side effects persist or cause severe distress for you, be sure to talk to your healthcare provider.

Common side effects include:

  • Cough
  • Dry mouth
  • Headaches
  • Sore throat
  • Sinusitis


Serious side effects are not common, but they can be harmful to your health. Be sure to talk to your healthcare provider promptly if you experience any severe side effects when taking this medication.

These include:

  • Any type of allergic reaction such as skin rash, hives, swelling of the face, lips, or tongue
  • Difficulty breathing
  • Changes in vision
  • Chest pain
  • Rapid heartbeat or heart palpitations
  • Infection or flu-like symptoms
  • Trouble passing urine or change in the amount of urine

Warnings and Interactions

Spiriva may interact with other anticholinergic drugs, causing additive side effects. These include antidepressants and anti-diarrhea medications.

If you aren't sure whether any of your other medications are anticholinergics, you can ask your pharmacist to review your list of medications to see if there are any potential interactions.

In 2008, the FDA placed a warning about the risk of stroke with this medication. While the warning was lifted, research still shows that this medication can increase the risk of cardiovascular disease, including strokes and heart attacks.

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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. SPIRIVA® HandiHaler label.

  2. Food and Drug Administration. SPIRIVA® RESPIMAT® label.

  3. Nici L, Mammen MJ, Charbek E, et al. Pharmacologic Management of Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine. 2020. 201(9). doi:10.1164/rccm.202003-0625ST

  4. Schmiedl S, Fischer R, Ibanez L, et al. Tiotropium Respimat(®) vs. HandiHaler(®): real-life usage and TIOSPIR trial generalizability. Br J Clin Pharmacol. 2016;81(2):379-88.doi:10.1111/bcp.12808

  5. Liou JT, Lin CW, Tsai CL, et al. Risk of severe cardiovascular events from add-on tiotropium in chronic obstructive pulmonary disease. Mayo Clin Proc. 2018;93(10):1462-1473.doi:10.1016/j.mayocp.2018.05.030