Tiotropium inhalers

Tiotropium inhalers are used to prevent symptoms of chronic obstructive pulmonary disease (COPD) and sometimes asthma, such as coughing, wheezing and feeling breathless.

Tiotropium belongs to a group of medicines called anticholinergic bronchodilators. It works by relaxing muscles in your lungs and widening your airways. This makes it easier for you to breathe.

Tiotropium inhalers (sometimes called "puffers") are known as preventer inhalers. If you have COPD or asthma, you'll use your inhaler regularly to help prevent you from getting symptoms.

Tiotropium inhalers are available on prescription only.

Some inhalers contain tiotropium mixed with other medicines that help your breathing, such as olodaterol. Brand names of tiotropium mixed with olodaterol are Spiolto Respimat and Yanimo Respimat.

Most adults and children aged 6 years old and over can use tiotropium inhalers.

Tiotropium inhalers are not suitable for some people. To make sure it's safe for you or your child, tell your doctor before starting to use it if you:

• have ever had an allergic reaction to tiotropium or any other medicine
• have glaucoma
• have prostate problems or difficulty peeing
• have had a heart attack in the last 6 months
• have an irregular heartbeat (arrhythmia) or heart failure

The usual dose of tiotropium is 1 or 2 puffs, taken once a day. Use it at the same time each day.

It's important to use your tiotropium inhaler regularly to manage your condition. Keep using it, even if you do not have any symptoms.

You'll usually stay on the same dose. If the brand of tiotropium inhaler you use changes, the number of puffs you need to take may change. You'll still only use the inhaler once a day.

There are different types of tiotropium inhaler.

Before using your inhaler, read the information leaflet that came with it. This leaflet contains instructions and diagrams to show you how to use the inhaler, how to keep it clean, and how long to use it before getting a replacement.

It's very important to use your inhaler properly. This is so you get the right amount of tiotropium into your lungs and the most benefit from your medicine.

After using your inhaler, always put the lid back on to keep it clean.

Unlike steroid inhalers, after using your tiotropium inhaler you do not need to rinse your mouth with water.

Inhalers with capsules

Some tiotropium inhalers use capsules that contain the medicine in a powder. Brands include:

• Braltus capsules, used with the Zonda device
• Spiriva capsules, used with the HandiHaler device

Put a new capsule into the device each time you use it.

The inhaler has a button that makes a hole in the capsule. You then breathe in the powder from the capsule through the mouthpiece on the inhaler.

Inhale from the device twice to make sure that you've inhaled all of the medicine and the capsule is empty.

Always store your capsules in the screw-top bottle or blister pack that comes with the capsules. Do not store them inside the inhaler. Always check that the mouthpiece is clear before using your inhaler.

Tiotropium inhalers that use cartridges include:

• Spiolto Respimat
• Spiriva Respimat
• Yanimo Respimat

The cartridge contains several doses, so you do not need to replace it each time you use your inhaler.

To get the most from your inhaler, it's important to have your technique checked regularly.

If you're not sure how to use your inhaler, or your technique has not been checked for a year, ask your doctor, nurse or a pharmacist to watch you use it.

You'll usually use your tiotropium inhaler for a long time, sometimes many years. It helps prevent your asthma or COPD getting worse.

It's important to keep using your inhaler even if you feel better.

If you forget a dose, use your inhaler as soon as you remember, unless you do not remember until the next day. In this case, skip the missed dose and have your next dose at the usual time.

Do not take 2 doses to make up for a forgotten dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

Using too much tiotropium can cause a dry mouth, a faster heartbeat or blurred vision.

• you use more than your prescribed dose of tiotropium and have a faster heartbeat or blurred vision.

Call 111 or get help from 111 online .

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the tiotropium packet or leaflet inside it, any remaining medicine, and any other medicines you take.

This common side effect of tiotropium inhalers may happen in more than 1 in 100 people. There are things you can do to help cope:

Try chewing sugar-free gum or sucking sugar-free sweets.

Speak to a doctor or pharmacist if this advice on how to cope does not help and a side effect is still bothering you or does not go away.

It's unusual to have any serious side effects when using a tiotropium inhaler.

Call a doctor or call 111 straight away if you have:

• difficulty sleeping (insomnia)
• blurred vision, red eyes, or you see rings around lights – these can be signs of glaucoma
• difficulty peeing (urinary retention)
• a faster heartbeat or can feel your heartbeat (heart palpitations)
• difficulty swallowing

Serious allergic reaction

In rare cases, tiotropium may cause a serious allergic reaction (anaphylaxis).

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of tiotropium inhalers. For a full list, see the leaflet inside your medicine packet.

You can use tiotropium inhalers during pregnancy.

It's important to manage your asthma or chronic obstructive pulmonary disease (COPD) while you're pregnant. Problems with breathing can be dangerous for you and your baby.

Speak to your doctor if you become pregnant while you're using tiotropium. They may want to review your medicine to check that you're on the best treatment for your asthma or COPD.

It's OK to use your tiotropium inhaler as normal while you're breastfeeding. This includes tiotropium inhalers that also contain olodaterol.

Although there is not much information about using tiotropium inhalers while breastfeeding, only tiny amounts are thought to pass into breast milk. Your baby will not be able to absorb a lot into their body, so it's very unlikely to cause them any side effects.

If you notice that your baby is not feeding as well as usual, or if you have any other concerns about your baby, talk to your health visitor, midwife, pharmacist or doctor as soon as possible.

There's no evidence to suggest that using tiotropium inhalers will reduce fertility in either men or women.

Tell your doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

It's unlikely that other medicines commonly used to treat chronic obstructive pulmonary disease (COPD) or asthma will affect or be affected by tiotropium inhalers.

There are some medicines that can increase the chance of side effects if taken with tiotropium.

Always check with your doctor or a pharmacist before starting any new medicine while you're using tiotropium inhalers.

There's not enough information to say that complementary medicines, herbal remedies and supplements are safe to take with tiotropium. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.