A long-acting "preventer" inhaler (LAMA)
Tiotropium
A once-daily long-acting inhaler that keeps the airways open in COPD, and is used as an add-on in some asthma.
What is Tiotropium?
Tiotropium is a long-acting bronchodilator of the LAMA type, taken as an inhaler once a day to keep the airways open. It is used mainly in chronic obstructive pulmonary disease (COPD) and sometimes in asthma, and is a maintenance treatment rather than a quick-relief inhaler.
Education and reference only. This is a plain-language guide to Tiotropium — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Tiotropium is a long-acting bronchodilator of the "LAMA" type (long-acting muscarinic antagonist). It is an inhaler taken regularly to keep the airways open and ease breathlessness, mainly in COPD, and as an add-on treatment in some people with asthma that is not controlled on their usual inhalers. Common brands include Spiriva and Braltus. The crucial point is that it is a maintenance ("preventer") inhaler taken regularly to keep symptoms at bay — it is NOT a reliever, and does nothing for a sudden attack of breathlessness, for which a separate fast-acting reliever inhaler is needed.
How it works
Tiotropium blocks a natural signal (acting on muscarinic receptors) that tells the muscles around the airways to tighten. By blocking this, it lets those muscles relax, so the airways stay wider and air moves in and out more easily. It is long-acting, keeping the airways open across the day from a single regular dose, which steadily reduces breathlessness and flare-ups in COPD over time rather than giving instant relief.
Company & origin
Originated / developed by: Boehringer Ingelheim.
Tiotropium bromide was developed by Boehringer Ingelheim in Germany as a long-acting inhaled anticholinergic bronchodilator, first marketed as Spiriva in Europe in 2002 and approved by the US FDA in 2004.
What it treats
Conditions Tiotropium is used for
Practical use
How to take Tiotropium
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Use it once a day, at around the same time each day, to keep the airways open continuously.
- It is a maintenance inhaler, not a reliever — it will not ease a sudden attack, for which a separate fast-acting reliever is used.
- Learn and use the correct device technique, as the inhaler types differ in how they are loaded and inhaled.
- Take care to keep the capsule or device powder out of your eyes, which can blur vision and cause discomfort.
- Tell your doctor about glaucoma, urinary problems or an enlarged prostate before starting.
- Keep using it regularly, even on good days, and seek advice if your breathing worsens.
Weighing it up
Advantages & disadvantages of Tiotropium
Advantages
- Provides steady, once-daily relief of breathlessness in COPD.
- Helps reduce flare-ups and can improve exercise tolerance.
- Convenient single daily dose.
- Acts mainly in the airways with limited whole-body effect.
Disadvantages
- Not a reliever, so a separate inhaler is still needed for sudden symptoms.
- Can cause dry mouth, throat irritation and constipation.
- May worsen glaucoma or urinary retention and contact with the eyes should be avoided.
- Requires correct device technique to work properly.
Practical use
Good to know
Use it regularly as a maintenance inhaler, not as a rescue treatment — keep your separate reliever for sudden symptoms. Inhaler technique is important and varies by device (some are dry-powder capsule devices, where the capsule is placed in the inhaler and pierced, not swallowed; others are soft-mist inhalers), so ask to have your technique checked. A common nuisance effect is a dry mouth. Because it is an anticholinergic medicine, it is used with care in people with certain types of glaucoma or with difficulty passing urine (such as an enlarged prostate). If you ever get sudden eye pain, blurred vision or haloes around lights, seek urgent eye assessment.
Who should not take it / use with caution
- It is a maintenance inhaler, not a reliever, and must not be relied on for a sudden attack.
- Used with caution in people with certain types of glaucoma (especially narrow-angle), an enlarged prostate, or difficulty passing urine.
- People with significant kidney problems, or who have had an allergic reaction to it or to atropine-type medicines, need careful assessment.
Monitoring
- Breathlessness, symptoms and flare-ups in COPD or asthma
- Inhaler technique for the specific device
- Any dry mouth, urinary difficulty, or new eye symptoms
Side effects
- Dry mouth (the most common effect), and sometimes a sore throat, cough or hoarse voice.
- Constipation or difficulty passing urine in those prone to it.
- Rarely, blurred vision or eye pain (possible angle-closure glaucoma — seek urgent eye care); occasionally palpitations.
Key interactions
- It is generally not combined with another inhaler of the same anticholinergic (LAMA) type, as this adds to the side effects.
- Care alongside other anticholinergic medicines (some for bladder, bowel or older antihistamines), which add to dry mouth, constipation and urinary effects.
- Few major interactions otherwise, but tell your prescriber about glaucoma or prostate problems.
Available as: Long-acting inhalers — a dry-powder capsule device (the capsule is pierced inside the inhaler, not swallowed) and a soft-mist inhaler. Taken regularly as maintenance, not as a reliever.
Answers
Tiotropium: frequently asked questions
Can I use tiotropium when I am breathless?
No — tiotropium is a long-acting maintenance ("preventer") inhaler that works slowly to keep your airways open over the day. It does not relieve sudden breathlessness, so you must keep a separate fast-acting reliever inhaler for that. If you are needing your reliever more often, let your respiratory team know.
I use the capsule inhaler — do I swallow the capsule?
No. With the dry-powder capsule device, the capsule is placed inside the inhaler and pierced, and you breathe the powder in through the device — the capsule itself is never swallowed. Ask your pharmacist or nurse to show you the technique, as using it correctly is essential for it to work.
Why does tiotropium give me a dry mouth?
Tiotropium is an anticholinergic medicine, and dry mouth is its most common side effect because it reduces some natural secretions. It is usually mild; sipping water, sugar-free sweets or gum can help. Tell your prescriber if it is troublesome or if you also notice constipation or difficulty passing urine.
I have glaucoma — is tiotropium safe for me?
It depends on the type. Tiotropium is used with caution in narrow-angle glaucoma, and you should mention any glaucoma to your prescriber. Take care that the spray or powder does not get into your eyes, and seek urgent eye assessment if you ever get sudden eye pain, blurred vision or haloes around lights.
What is the difference between tiotropium, Spiriva and Braltus?
They contain the same active ingredient — tiotropium is the generic name, while Spiriva and Braltus are brand names (using different inhaler devices). The active medicine is the same; the main difference is the device, so it is important to learn the technique for the specific inhaler you are given.
The wider class
About Long-acting bronchodilators
Tiotropium belongs to the long-acting bronchodilators class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF: Tiotropium.
- NICE NG115: Chronic obstructive pulmonary disease in over 16s.
- NICE CKS: Tiotropium inhalers.
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