Spiriva for Asthma
Back in June, my respirologist, Dr. Smartypants, and I discussed a plan to (maybe, hopefully) allow me to keep my inhaled steroid dose lower through the rough Winter months. That plan involves swapping out the Atrovent I’ve been using since 2010 for Spiriva. Atrovent and Spiriva are both anti-cholinergic bronchodilators that can be used as an add-on treatment when high dose inhaled corticosteroids and long-acting bronchodilators are insufficient on their own to control asthma. Atrovent is a short-acting anticholinergic, which acts more quickly but lasting only 6 hours.
Managing asthma in the winter
Conversely, Spiriva is a long-acting variety, beginning to work within 1 hour but with effects lasting for 24 hours. Both the FDA and Health Canada approved the additional use of Spiriva in the Respimat device for asthma in 2015.1,2 I titrate my Atrovent dose based on my symptoms from 2 times a day to 4, so we’ve in the past refrained from switching to this “easier” once daily dosing format of Spiriva, because it would overall equate to more drug, not less.
However, Winter seems to be officially upon us—a half hour before I left for my appointment with Dr. Smartypants, I texted Dia a screenshot of the weather: a balmy (*sarcasm*) -13*C with a “feels like” (+windchill) temperature of -23*C on November 9th. Wandering in to Dr. Smartypants’ office with a cold and cold weather upon us, we had a chat about my asthma, she dug out a couple Spiriva Respimat samples, showed me how it works (I’ll cover more about the Respimat device itself soon!), and I was on my way.
How anticholinergics work for asthma
While I’m not usually into getting my science directly from Big Pharma, this time around, the makers of Spiriva made a really useful and easy-to-understand video to help explain how anticholinergic drugs, like Spiriva, work in the lungs to help manage asthma.3 Here’s a link to the Mechanism of Action video. The function is different than that of other long-acting beta-2 agonists, like salmeterol and formoterol, and anticholinergics may work as well or perhaps better than standard therapy for some patients.4 Anticholinergics, like tiotropium (Spiriva), work on three pathways to improve asthma—the video guy can explain it much better than me. Essentially, though, tiotropium binds to a certain receptor cell, M3 receptors, blocking a neurotransmitter called acetylcholine, and thus relaxing airway smooth muscle, impairing inflammatory cells, and decreasing mucus secretion, all of which narrow airways in asthma.3 While tiotropium is taken once a day, its effects build up over time, such as in inflammatory cells, which is why full benefit may not be felt for several weeks.
Science and how Spiriva is working for me so far
In a study published in 2010—at Spiriva’s infancy for asthma treatment—a Wake Forest University researcher found Spiriva used instead of doubling the inhaled corticosteroid (ICS) dose was “much more effective”.4 This may just be one study but it gives me hope, as Dr. Smartypants reasoned we may be able to keep my ICS lower this winter if I switch to Spiriva, as I end up needing to increase it for most of the winter.
Time will tell! So far, it seems to be working quite well, which does not come as a surprise as I’ve responded well to Atrovent for 8 years!
Making tweaks and changes to my asthma management plan can be a bit daunting, as I’m on multiple asthma medications and generally they work okay for me—I’m always a bit edgy given I have experience with a med swap that made me much sicker! However, my eagerness to try something new usually wins out because it could help me take less medication overall—time (and temperature) will tell if that’s the case here!
Have you ever gotten "moon face" as a side effect of prednisone?