SPIOLTO® Respimat® (tiotropium + olodaterol) for COPD

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Graham (This is a fictional patient)Monotherapy (LAMA) with SPIRIVA® Respimat® SMI
Shirley (This is a fictional patient)Dual Therapy (LAMA + LABA) with DPI

Graham (This is a fictional patient)Monotherapy (LAMA) with SPIRIVA® Respimat® SMI

Graham was diagnosed with chronic obstructive pulmonary disease (COPD) 6 months ago, and has been prescribed SPIRIVA® Respimat® (tiotropium), a LAMA monotherapy delivered via the Respimat® Soft Mist Inhaler (SMI).

In his spare time, he likes to go for long walks in the countryside. But, when going uphill or picking up pace, he feels increasingly breathless.

Current presentation	Increasingly breathless when walking uphill or picking up pace
Current treatment	LAMA — SPIRIVA® Respimat® (tiotropium)
Adherence	Good
Inhaler technique	Good
Eosinophil count	100 cells/mm³ (normal)
Exacerbation in the last 12 months	No exacerbations

Graham’s symptoms are not being controlled with LAMA monotherapy despite his inhaler technique and adherence to treatment both being good. NICE and GOLD guidelines recommend switching to a LAMA + LABA dual therapy if a person with good technique and adherence is limited by symptoms despite receiving monotherapy.^1,2

Consider switching Graham from SPIRIVA® Respimat® to SPIOLTO® Respimat® (tiotropium + olodaterol), a LAMA + LABA dual therapy in the Respimat® inhaler that he is familiar with.

Benefits of switching to SPIOLTO® Respimat® from SPIRIVA® Respimat®

SPIRIVA® Respimat® (tiotropium) is indicated as a maintenance bronchodilator treatment to relieve symptoms of adult patients with COPD.

SPIOLTO® Respimat® (tiotropium + olodaterol) is indicated as a maintenance bronchodilator treatment to relieve symptoms in adult patients with COPD.

Footnotes / abbreviations

The details of this case are fictional and created for educational purposes only.
COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist; NICE, National Institute for Health and Care Excellence.

References

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2023 Report. Available at: https://goldcopd.org/wp-content/uploads/2023/03/GOLD-2023-ver-1.3-17Feb2023_WMV.pdf. (Accessed November 2023).
National Institute for Health and Care Excellence (NICE). Chronic obstructive pulmonary disease in over 16s: diagnosis and management (NG115). 2016. Available at: https://www.nice.org.uk/guidance/ng115/resources/chronic-obstructive-pulmonary-disease-in-over-16s-diagnosis-and-management-pdf-66141600098245. (Accessed November 2023).

Shirley (This is a fictional patient)Dual Therapy (LAMA + LABA) with DPI

Shirley was diagnosed with chronic obstructive pulmonary disease (COPD) 4 months ago, and is currently on dual therapy (LAMA + LABA) delivered by a dry powder inhaler (DPI).

She has been struggling to exercise, which has caused her condition to worsen. Shirley's symptoms include severe breathlessness and she has a suboptimal peak inspiratory flow (sPIF).

sPIF defined as peak inspiratory flow rate <60 L/min.¹

Current presentation	Condition has worsened and she is struggling to exercise
Current treatment	LAMA + LABA delivered through a DPI
Adherence	Good
Inhaler technique	Moderate, due to sPIF
Eosinophil count	150 cells/mm³ (normal)
Exacerbation in the last 12 months	One exacerbation (no hospitalisation required)
Peak Inspiratory Flow	40 L/min (suboptimal)

Shirley’s symptoms are not being controlled on her LAMA + LABA treatment with a DPI inhaler. Some DPIs require a forceful inhalation to optimally separate the medicine from carrier particles.^2,3 Shirley has sPIF, which may be associated with suboptimal delivery of medication.¹ It might be time to review and discuss the choice of inhaler with Shirley.

A switch to an SMI, like SPIOLTO® Respimat® (tiotropium + olodaterol), could help patients like Shirley achieve greater lung deposition compared to certain DPIs, as shown in an in vitro and in silico study;*^4,5 The Respimat® Soft Mist Inhaler provides a consistent dose to the lungs, independent of inspiratory ability*^†4,5 Furthermore, SPIOLTO® Respimat® delivers significant lung function improvements compared to placebo irrespective of the PIF a patient can generate (p<0.0001).^‡6

Benefits of switching to SPIOLTO® Respimat® from a DPI

SPIOLTO® Respimat® (tiotropium + olodaterol) is indicated as a maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD).

Footnotes / abbreviations

The details of this case are fictional and created for educational purposes only.

These studies simulated the upper airways (in vitro) and the lower airways (in silico) of patients with moderate and very severe COPD.

†

Lower inspiratory effort expected to achieve optimal flow rate from an in vitro study, where air flow resistance was compared between different devices at specified flow rates. Recommended inspiratory flow rates are specific to each device.

‡

A randomised, placebo-controlled study of tiotropium + olodaterol delivered via the Respimat® Soft Mist Inhaler in 213 patients with moderate-to-severe COPD stratified by peak inspiratory flow (PIF <60 L/min; PIF ≥60 L/min). Study endpoints were changes from baseline in FEV₁ AUC_0–3 (primary) and trough FEV₁ (secondary) at 4 weeks.⁵

AUC_0–3, area under the curve from 0 to 3 h; COPD, chronic obstructive pulmonary disease; DPI, dry powder inhaler; FEV₁, forced expiratory volume in 1 s; ICS, inhaled corticosteroids; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist; PIF, peak inspiratory flow; pMDI, pressurised metered-dose inhaler; SMI, soft mist inhaler; sPIF, suboptimal peak inspiratory flow.