The Tiova Inhaler (Tiotropium Bromide) is a long-acting muscarinic antagonist (LAMA) designed for the maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. It works by relaxing the muscles around the airways, helping to keep them open and making breathing easier for up to 24 hours with a single dose. Clinically proven to improve lung function, exercise tolerance, and quality of life, it is a cornerstone in the management of moderate to severe COPD. Proper inhaler technique is essential for optimal drug delivery and efficacy.

Features

• Contains Tiotropium Bromide 18 mcg per inhalation
• Delivered via a breath-actuated, propellant-free Respimat Soft Mist Inhaler
• Provides 24-hour bronchodilation with once-daily dosing
• Each cartridge contains 60 metered doses (30-day supply with once-daily use)
• Portable, pocket-sized device with dose counter
• Requires minimal inspiratory effort for effective drug delivery

Benefits

• Significantly improves forced expiratory volume in one second (FEV1) and reduces hyperinflation
• Decreases the frequency and severity of COPD exacerbations
• Enhances exercise capacity and reduces breathlessness during daily activities
• Sustained 24-hour airway patency supports uninterrupted sleep and daytime symptom control
• Reduces the need for rescue medication use
• Contributes to improved health-related quality of life scores in clinical studies

Common use

Tiova Inhaler is indicated for the long-term, once-daily maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD). It is prescribed for patients with chronic bronchitis and/or emphysema who experience persistent respiratory symptoms such as dyspnea, cough, and sputum production. It is not indicated for the initial treatment of acute bronchospasm or for asthmatic patients, unless specifically recommended by a pulpmonologist in cases of asthma-COPD overlap syndrome (ACOS) under careful supervision.

Dosage and direction

The recommended dosage is one inhalation (18 mcg of Tiotropium Bromide) once daily, at the same time each day. To use the Respimat inhaler: remove the clear base and insert the cartridge into the inhaler until it clicks. Turn the base in the direction of the arrows until it clicks (half-turn), then press the dose-release button to prime the inhaler. Repeat this priming process three more times. For dosing, turn the base until it clicks, exhale fully away from the mouthpiece, place lips tightly around it, press the button while slowly inhaling deeply, and hold breath for 10 seconds if possible. The dose counter will track remaining doses. The inhaler should be tested monthly for patency and cleanliness.

Precautions

• Not for relief of acute bronchospasm; always keep a fast-acting rescue inhaler (e.g., SABA) available.
• Patients with narrow-angle glaucoma, urinary retention, or severe renal impairment (CrCl ≤50 mL/min) should use with caution and be monitored.
• Immediate hypersensitivity reactions, including angioedema, may occur; discontinue if suspected.
• Avoid eyes during administration; may cause blurred vision or pupil dilation.
• Paradoxical bronchospasm may occur; substitute alternative therapy if it develops.
• Be aware of new or worsening urinary symptoms, especially in men with prostatic hyperplasia.
• Use during pregnancy only if clearly needed; animal studies show fetal toxicity at high doses.
• Not recommended in pediatric patients; safety and efficacy have not been established.

Contraindications

• Hypersensitivity to tiotropium bromide, atropine or its derivatives, or any component of the formulation.
• Patients with a history of hypersensitivity reactions such as rash, urticaria, or angioedema to anticholinergic agents.

Possible side effect

Common adverse reactions (≥3% incidence) include:

• Dry mouth
• Upper respiratory tract infection
• Sinusitis
• Pharyngitis
• Non-specific chest pain
• Constipation
• Dyspepsia
• Urinary tract infection

Less common but serious side effects may include:

• Glaucoma (eye pain, blurred vision, visual halos)
• Urinary retention (difficulty urinating)
• Tachycardia or palpitations
• Allergic reactions (rash, itching, swelling)
• Paradoxical bronchospasm (worsening breathing immediately after use)

Drug interaction

• Concomitant use with other anticholinergic-containing drugs (e.g., ipratropium, aclidinium) may increase side effects such as dry mouth, urinary retention, and constipation.
• May interact with drugs that are excreted renally via active secretory pathways (e.g., metformin, cimetidine); monitor for increased effects.
• No clinically significant pharmacokinetic interactions observed with commonly used COPD medications like inhaled corticosteroids, sympathomimetics, or methylxanthines.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. However, if it is nearly time for the next scheduled dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Maintaining a consistent daily routine improves therapeutic outcomes.

Overdose

Overdose may lead to exaggerated anticholinergic effects such as severe dry mouth, visual disturbances, tachycardia, urinary retention, constipation, and possible delirium. There is no specific antidote for tiotropium overdose. Treatment is symptomatic and supportive. In case of ingestion or excessive inhalation, seek immediate medical attention. Dialysis is not effective due to high protein binding and large volume of distribution.

Storage

Store at room temperature (15–30°C). Keep the cartridge in the sealed blister pack until first use. Protect from moisture and freezing. After insertion into the inhaler, use within 3 months. Keep out of reach of children and pets. Do not puncture or incinerate, even when empty.

Disclaimer

This information is for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for personalized recommendations based on your medical history, current condition, and concomitant medications. Do not initiate or discontinue therapy without clinical supervision.

Reviews

Clinical studies and patient reports consistently highlight the efficacy of Tiova Inhaler in managing COPD symptoms. In pivotal trials, patients demonstrated significant improvement in lung function (FEV1 AUC 0–24h) and reduced need for rescue medication. User feedback often notes the convenience of once-daily dosing and the reliability of the Respimat delivery system, though some users report initial difficulty with inhaler technique. Adherence to proper inhalation instructions is frequently emphasized for optimal results. Overall, it is regarded as a well-tolerated and effective maintenance therapy in real-world COPD management.