Friday, November 4, 2016

Switching Tiotropium Handihaler to Respimat Soft Mist


  • Tiotropium (Spiriva) is licensed as a maintenance bronchodilator treatment to relieve symptoms of COPD. 
  • Tiotropium can be delivered in two ways:
    • via the HandiHaler inhaler once daily, from a capsule containing 18 micrograms of tiotropium
    • via the soft-mist Respimat inhaler taken as two puffs once daily (2.5 micrograms of tiotropium delivered per puff)
Efficacy
  • In Japanese patients with COPD, tiotropium Respimat® 5 μg and tiotropium HandiHaler® 18 μg showed a similar profile of efficacy, safety and pharmacokinetics
  • There was a study showed that no major problem in switching from Tiotropium Handihaler to Respimat. Respimat and Handihaler showed similar effects and usability.
Adverse Events
  • risk for mortality in chronic obstructive pulmonary disease (COPD) patients being treated with tiotropium is the same whether the drug is delivered by the Respimat Soft Mist Inhaler or the HandiHaler device, a large, long-term study has found
  • In the 17,000 COPD patients followed for more than 2 years, there were no statistically significant differences in rates of mortality, myocardial infarction, or stroke between the 2 tiotropium delivery systems
  • the finding is in direct contrast to those from smaller investigations that have questioned the safety of tiotropium delivered by the Respimat device 
Technique
  • in general, both inhalers were considered to be easy to use
  • The Respimat reportedly has high levels of satisfaction in COPD patients, due to its inhalation and handling characteristics
  • The preference for the Respimat increased with continued use.
 References:
  1. https://www.gov.uk/drug-safety-update/tiotropium-delivered-via-respimat-compared-with-handihaler-no-significant-difference-in-mortality-in-tiospir-trial
  2. http://www.ncbi.nlm.nih.gov/pubmed/22691112
  3. http://reference.medscape.com/drug/spiriva-handihaler-spiriva-respimat-tiotropium-343446
  4. http://www.medscape.com/viewarticle/811257#vp_1
  5. http://www.resmedjournal.com/article/S0954-6111%2809%2900375-8/abstract
  6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293296/ 
  7. http://bmjopen.bmj.com/content/5/5/e006619.full

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