Ngyugen asked
What is the difference in Spiriva Handihaler and the Spiriva Respimat? I have always used the original Spiriva but my new prescription is for the Respimat version.
Answer
Although Spiriva HandiHaler and Spiriva Respimat both contain the active ingredient tiotropium, there are several important differences between the two medications. The key differences include different delivery devices, different indications for treatment, and slightly different side effects.
Difference Between Spiriva Handihaler & Spiriva Respimat
The delivery devices for the HandiHaler and Respimat are quite a bit different. Inhaler technique is critical to ensure the drug reaches the lungs so it is important to understand how to use each type of device. The Handihaler is the traditional delivery device for Spiriva. The technique for using the device includes adding a capsule to the device, puncturing the capsule, and rapidly and forcefully inhaling the contents. Each capsule should be inhaled twice to ensure the entirety of the contents are inhaled. Some patients find it difficult to inhale the entire contents of the capsule.
The recently approved Spiriva Respimat is available as a “slow-moving mist” inhaler. Spiriva Respimat is recommended to be taken as two inhalations for each dose. The acronym TOP can be used according to the manufacturer to remember the administration steps:
- Turn the clear base
- Open the cap and close your lips around the mouthpiece
- Press the dose-release button and inhale
The next difference is the indications for treatment for these inhalers. Spiriva HandiHaler is only indicated for the treatment of COPD, emphysema, and chronic bronchitis to reduce COPD exacerbations. The Handihaler is used at a dose of 18 mcg once per day. Spiriva Respimat is also used for COPD, bronchitis, and emphysema for COPD exacerbation reduction, but it can also be used for asthma maintenance therapy. The dose for COPD is 5 mcg once per day and the asthma dose is 2.5 mcg once per day.
The final difference between Handihaler and Respimat is the side effect profile. Although both contain the same active ingredient, the delivery device and formulation has been shown to change the side effects. The Respimat may reduce dry mouth as compared to Handihaler. The Respimat has shown an increase in cough in the first few weeks of therapy. The majority of patients prefer using and handling the Respimat as compared to the Handihaler.
