Nursing in Practice May/June 2020 (issue 114)

Promotional in The onl 6 years The SPIRIVA ® Respim is designed for us up to 6 cartridges 1 st month 2nd 3rd 4th By using one Respimat ® with six cartridg is reduced by 71% compared with u SPIRIVA ® Respimat ® is indicated as add-on maintenance bronchodilato experienced one or more severe asthm LAMA: long-acting muscarinic antagonist. References: 1. Spiriva ® Respimat ® 2.5 μg Summary of Product Characteristics; 2. Kamin W et al. Pulm Ther 2015;1:53–63; 3. Hansel M et al. Adv Ther 2019;36(9):2487–2492 Date of preparation: March 2020. PC-GB-101379 Prescribing Information (UK) SPIRIVA ® RESPIMAT ® (tiotropium) Inhalation solution containing 2.5 microgram tiotropium (as bromide monohydrate) per puff. Indication: COPD: Tiotropium is indicated as a maintenance bronchodilator treatment to relieve symptoms of patients with chronic obstructive pulmonary disease (COPD). Asthma: Spiriva Respimat is indicated as add-on maintenance bronchodilator treatment in patients aged 6 years and older with severe asthma who experienced one or more severe asthma exacerbations in the preceding year. Dose and Administration: COPD Adults only age 18 years or over: 5 microgram tiotropium given as two puffs from the Respimat inhaler once daily, at the same time of the day. Asthma Adults and patients 6 to 17 years of age: 5 microgram tiotropium given as two puffs from the Respimat inhaler once daily, at the same time of the day. In adult patients with severe asthma, tiotropium should be used in addition to inhaled corticosteroids (≥ 800 μg budesonide/day or equivalent) and at least one controller. In adolescents (12 - 17 years) with severe asthma, tiotropium should be used in addition to inhaled corticosteroids (> 800 - 1600 μg budesonide/day or equivalent) and one controller or in addition to inhaled corticosteroids (400 - 800 μg budesonide/day or equivalent) with two controllers. For children (6 - 11 years) with severe asthma, tiotropium should be used in addition to inhaled corticosteroids (> 400 μg budesonide/day or equivalent) and one controller or in addition to inhaled corticosteroids (200 - 400 μg budesonide/day or equivalent) with two controllers. Contraindications: Hypersensitivity to tiotropium bromide, atropine or its derivatives, e.g. ipratropium or oxitropium or to any of the excipients; benzalkonium chloride, disodium edetate, purified water, hydrochloric acid 3.6 % (for pH adjustment). Warnings and Precautions: Benzalkonium chloride may cause wheezing and breathing difficulties; patients with asthma are at an increased risk for these adverse events. Not for the initial treatment of acute episodes of bronchospasm or for the relief of acute symptoms. Spiriva Respimat should not be used as monotherapy for asthma. Asthma patients must be advised to continue taking anti-inflammatory therapy, i.e. inhaled corticosteroids, unchanged after the introduction of Spiriva Respimat, even when their symptoms improve. Immediate hypersensitivity reactions may occur after administration of tiotropium bromide inhalation solution. Caution in patients with narrowangle glaucoma, prostatic hyperplasia or bladderneck obstruction. Inhaled medicines may cause inhalation-induced bronchospasm. Tiotropium should be used with caution in patients with recent myocardial infarction < 6 months; any unstable or life threatening cardiac arrhythmia or cardiac arrhythmia requiring intervention or a change in drug therapy in the past year; hospitalisation of heart failure (NYHA Class III or IV) within the past year. These patients were excluded from the clinical trials and these conditions may be affected by the anticholinergic mechanism of action. In patients with moderate to severe renal impairment (creatinine clearance ≤ 50 ml/min) tiotropium bromide should be used only if the expected benefit outweighs the potential risk. Patients should be cautioned to avoid getting the spray into their eyes. They should be advised that this may result in precipitation or worsening of narrow-angle glaucoma, eye pain or discomfort, temporary blurring of vision, visual halos or coloured images in association with red eyes from conjunctival congestion and corneal oedema. Should any combination of these eye symptoms develop, patients should stop using tiotropium bromide and consult a specialist immediately. Tiotropium bromide should not be used more frequently than once a day. Interactions: Although no formal

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