British Lung Foundation
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Spiriva - I'm mystified

Yesterday am I put a cap into my Handihailer, pressed the button and drew a breath........not very satisfactory I thought. I drew another breath - also no change and so I opened the HH and looked at the cap. It only had one hole pierced! I split the cap and a small amount of powder could be seen - not a lot. I thought to myself....Did I get a dose or not! So for the first time a used a second cap (regardeded as a No No! - but what the hell. Strangely, I was able to go for a reasonably long walk (long for me anyway LOL). The question is did I get one dose or two and/or did the second dose increase the benefit from taking Spiriva despite what the recommendation is? I really don't know. Stay well. Martin

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Hmmm...who knows? On the back of all previous comments tis a strange one for sure!

Could you please repeat experiment tomorrow and let me know the results? Hahaha lol ;)

Sometimes the hh doesnt feel as if its worked.pls be carefull you can overdose on it,

I've been doing two ihhalations to make sure I get it all after noticing there was still a little bit of powder left in the capsule when I squeezed it before throwing it away! Do you know what happens if you overdose the dose?

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No-one's alive to tell the tale! Joke! I seem to remember a while ago Jo,BLF said you mustn't ever take more than one capsule. A long time ago I thought I hadn't got the dose so did another one and worried myself silly. Didn't experience anything untoward that time but sometimes I feel it hasn't worked but won't take another one after reading what Jo had said. My problem is it often makes me cough and I wonder if it wasn't all coughed up again but even then I won't take another! Maybe they should make the powder shocking pink or something, at least we might be able to see remnants left in the mouth. Libby PS - I was told when prescribed it to do 2 inhalations on one capsule anyway, so that's what I always do. Libby

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Hello Martin,

I copied this excerpt from the GOLD Report (2013).

Ipratropium Bromide is the active bit in Atrovent.

Tiotropium Bromide is the active bit in Spiriva.


The most important effect in COPD

patients of anticholinergic medications, such as ipratropium,

oxitropium and tiotropium bromide, appears to be blockage

of acetylcholine’s effect on muscarinic receptors. Current

short-acting drugs block M2 and M3 receptors and modify

transmission at the pre-ganglionic junction, although these

effects appear less important in COPD. The long-acting

anticholinergic tiotropium has a pharmacokinetic selectivity

for the M3 and M1 receptors. The bronchodilating

effect of short-acting inhaled anticholinergics lasts longer

than that of short-acting beta2-agonists, with some

bronchodilator effect generally apparent up to 8 hours after

administration. Tiotropium has duration of action of more

than 24 hours. Tiotropium reduces exacerbations and

related hospitalizations, improves symptoms and health

status(Evidence A), and improves the effectiveness

of pulmonary rehabilitation(Evidence B). In a large,

long-term clinical trial on patients with COPD, there was

no effect of tiotropium added to other standard therapies

on the rate of lung function decline and no evidence of

cardiovascular risk. In another large trial, tiotropium was

superior to salmeterol in reducing exacerbations although

the difference was small.

Adverse effects.

Anticholinergic drugs are poorly absorbed

which limits the troublesome systemic effects seen with

atropine. Extensive use of this class of inhaled agents

in a wide range of doses and clinical settings has shown

them to be very safe. The main side effect is dryness of

the mouth. Twenty-one days of inhaled tiotropium, 18 mcg/

day as a dry powder, does not retard mucus clearance

from the lungs. Although occasional prostatic symptoms

have been reported, there are no data to prove a true

causal relationship. Some patients using ipratropium report

a bitter, metallic taste. An unexpected small increase

in cardiovascular events in COPD patients regularly

treated with ipratropium bromide has been reported and

requires further investigation. Tiotropium delivered

via the Respimat soft mist inhaler has been shown to be

associated with a significantly increased risk of mortality

compared with placebo. Caution is urged until further

studies designed to compare delivery devices and doses

are reported. Use of solutions with a facemask has

been reported to precipitate acute glaucoma, probably by a

direct effect of the solution on the eye.


link to this is:

and scroll down to page 40 (of 99)

What I understand from this is that the Dry Powder Inhaler version of Spiriva holds a very low risk of adverse effects associated with 'overdose'. There are only so many receptors in the lungs to be acted upon, and once these receptors are all 'switched', then any extra drug is of no use. Patients tend to get pressure from Doctors and respiratory nurses to be careful not to take too much, probably because of the cost.

'Respimat' I think presents a problem because as it is liquid form (dissolved), it is more readily absorbed allowing the Atropine to build to risky levels in susceptible patients.

Hope this helps,

breathe easy


Sometimes that happens to me, I just use another capsule.

I dont have problems. I always check that there are two holes. When I first got the spiriva I used to press a second time to make sure, which is unnecessary. I had to make sure I didn't pop the capsule in my mouth.

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I always open the capsule after after in hailing it,just to make sure it is empty

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I use spiriva,before I inhale onbrez.Have taken spiriva for years,only 12 months on onbrez(very happy with it) I was told to inhale twice with the spiriva,to make sure it's all used.

One gripe though! It annoys me,you have to pay for a new spiriva inhaler,& yet you get a new one each time,with your onbrez monthly script!

The other thing,with the spiriva,make sure you pierce holding it on a stable surface,if held in the air,might not pierce properly.I would advise you not to use extra capsule,as you could overdose with it! Good luck with it all!

Beautiful autumn day again,you will have to get back on your bike!

Cheers Wendells xx

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Wendell's. I had the same problem with Spiriva in that I did not always receive an inhaler. The Doctor can easily rectify that by including " plus inhaler" on your prescription.

Thanks for the tip! Dont know if that works in Aus. but will give it a try xx

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