Spiriva® inhaler for COPD and asthma available online

Spiriva® (tiotropium bromide) is a prescription inhalation spray for chronic obstructive pulmonary disease (COPD) and severe asthma when not controlled by other medications. This powerful drug helps open the lungs’ airways, making breathing easier. Schedule an online appointment with one of our board-certified physicians to see if Spiriva® is the right medication for you.*

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Can be used for maintenance treatment to prevent symptoms

Taken once a day for long-lasting relief

Maintain continuity in COPD and asthma care by consulting with an online doctor

*Prescriptions are provided at the doctor’s discretion. Learn more about our controlled substances policy and how you can save up to 80% with our prescription discount card.

How the Spiriva® inhaler works to manage COPD and asthma

Spiriva® has been shown to help manage asthma and reduce the risk of COPD flare-ups. It belongs to a class of drugs called anticholinergic agents. Spiriva® binds to receptors in the lungs in a way that helps the airways relax. Doctors prescribe it as a long-term, once-daily medication, to improve airflow in COPD and severe asthma when indicated. 

For asthma management, it’s also used as a long-term, once-daily maintenance treatment. It can be used alone or with inhaled corticosteroids (ICS), or with a combination of ICS and LABA (long-acting bronchial inhalers). Spiriva® is not used for acute flare-ups.

Tiotropium, the active ingredient of Spiriva® Respimat®, is delivered to the lungs in a special inhaler that sprays a pre-measured dose in a slow-moving mist. Spiriva® Respimat® and Spiriva® HandiHaler® deliver the active ingredient tiotropium in slightly different forms.

PlushCare telemedicine provides compassionate COPD and asthma care

According to the CDC, COPD conditions such as chronic bronchitis and emphysema can be both fatal and disabling for millions of Americans. Getting regular medical care to manage symptoms and prevent flare-ups is essential.  By providing quality online telemedicine, our doctors make it easier to get the ongoing, compassionate treatment you need to manage your breathing symptoms and enjoy a healthier quality of life.

  • Seven lifestyle tips to help COPD and asthma symptoms

    • See your doctor regularly: Regular doctor visits allow your doctor to carefully manage your treatment plan to minimize flare-ups and side effects. 

    • Avoid pollution: Pollutants irritate the airways of your already sensitive lungs. A high-quality HEPA filter can help keep your home's indoor air clean.  

    • Quit smoking: Smoking, vaping, or marijuana use can all contribute to inflammation in your lungs. Our doctors can help you with treatment plans to quit smoking.

    • Take precautions to prevent the flu: Getting the flu shot every year is imperative. Avoid crowded places during the flu season and practice good hygiene.

    • Get the Pneumovax, if recommended: Adults aged 19 to 64 years with predisposing chronic medical conditions, such as chronic lung disease, chronic liver disease, or diabetes mellitus, should talk to their doctor about getting a pneumococcal vaccine.

    • Eat a balanced diet: Eating a variety of fruits and vegetables helps reduce lung inflammation by providing various healthy phytochemicals and antioxidants. 

    • Make gentle exercise a healthy habit: Regular exercise helps reduce stress and oxygenate your lungs.

Spiriva Respimat inhaler vs. Spiriva HandiHaler®

The Spiriva® Respimat® soft mist inhaler and HandiHaler® both deliver the drug tiotropium bromide to the lungs for COPD or asthma relief. They are a little different in how they are delivered; your doctor will help you decide the right prescription. Most patients (79.5%) prefer the Respimat® over the HandiHaler®, especially once they get used to it.(2)  A generic version of the Spiriva® HandiHaler®, called LupinHaler, was launched in the U.S. in August of 2023, making it the more affordable option. 


Spiriva® Respimat® inhaler

Spiriva® HandiHaler®

Type of device

Soft mist inhaler

Dry powder inhaler

Medication form

Liquid medication turned into a mist

Dry powder capsules

Inhalation process

Slow-moving mist that’s easy to inhale

Requires inhaling powder from capsules

Ease of use

Generally considered easier for patients with less lung power

Requires more forceful inhalation


Compact and portable

Compact and portable

Dosage measurement

Automatically measures dose per puff

One capsule per use


Requires regular cleaning

Requires minimal cleaning

Common uses

Often used for COPD, asthma

Primarily used for COPD

Power source

Mechanically powered, no propellant needed

Human breath-activated

Environmental impact

More environmentally friendly compared to traditional metered-dose inhalers

Less environmental impact than metered-dose inhalers but more than Respimat®


May be more expensive than HandiHaler®

Generally less costly than Respimat®

What are the pros and cons?



  • The Spiriva® inhalation spray uses soft mist technology, allowing more medicine to get into your lungs. 

  • Spiriva® helps open your airways, making breathing and oxygenating your lungs easier.

  • It must only be used once daily, making it convenient and easy to use, even for patients with serious health issues. 

  • The design of the Spiriva® Respimat® inhaler is intuitive and easy to use.  

  • Regular use has decreased the frequency and severity of respiratory flare-ups.


  • Some users may experience side effects such as dry mouth, throat irritation, or constipation. Talk to your doctor if you have any concerns. 

  • The cost of Spiriva® may make it inaccessible for some people, depending on insurance coverage. 

  • Spiriva® is generally not recommended for pregnant or breastfeeding mothers. 

  • There is a risk of potential systemic side effects associated with Spiriva®. While the localized nature of inhaler use helps reduce the impact, it’s still important to notice signs and symptoms.

Possible side effects of Spiriva® (tiotropium) inhaler

The most common side effects of Spiriva® are: 

The most common side effects will diminish over time. If you notice any side effects with the Spiriva® inhaler that are persistent or severe, it’s essential to talk to your doctor or pharmacist right away. 

Other less severe side effects include insomnia, cataracts, eye pain, blurry vision, nosebleeds, rhinitis, laryngitis, difficulty swallowing, gingivitis, chest pain and palpitations, joint swelling, abdominal pain, GERD, abnormal liver function test, dysuria, urinary retention, angioedema, dry skin, herpes zoster, and dehydration.

With any drug, there is always the risk of a life-threatening allergic reaction, including difficulty breathing, rash, itching, swelling, or severe dizziness. In the event of any allergic reaction, immediate medical attention is necessary.

Ingredients, dosage, and instructions

  • Each Spiriva® capsule with the HandiHaler® delivers 18 cg of tiotropium bromide monohydrate, equivalent to 22.5 mcg. Inactive ingredients in the capsule include lactose monohydrate and the gelatin used in the capsule shell. The lactose monohydrate may contain milk protein.

    Spiriva® Respimat® is available in two dosage strengths. Each inhalation of the Spiriva® Respimat® delivers 1.25 mcg or 2.5 mcg of tiotropium (equivalent to 1.562 mcg or 3.124 mcg, respectively, of tiotropium bromide monohydrate) from the mouthpiece. Two inhalations equal one dose (2.5 mcg or 5 mcg). Each cartridge of Spiriva® Respimat® lasts for 30 days if used as one inhalation per day.

    It is important to note that only a qualified doctor can determine the most appropriate dosage for you. Your doctor will provide you with personalized instructions on how to take your medication. However, there are some general guidelines.

  • How should I use my Spiriva® HandiHaler®?

    1. Capsule preparation: Each Spiriva® strip contains five capsules. For your dose, release one capsule from the strip. Place the Spiriva® capsule into the capsule chamber.

    2. Device setup: Close the mouthpiece until you hear it click. Pierce the capsule by pressing the green button.

    3. Inhalation: Sit up and breathe out. Place your mouth around the mouthpiece to form a tight seal. Breathe rapidly and deeply until your lungs are full.

    4. Hold your breath: Remove the inhaler from your mouth and hold your breath for 10 seconds. Breathe out through your mouth.

    5. Repeat for full dose: You must repeat the process (steps 3-5) for the second inhalation (twice for the one capsule to get your entire dose). No need to pierce the capsule again.

    6. Discard and close: Open the mouthpiece and discard the used capsule. Close the mouthpiece and then close the lid of the inhaler.

    7. Device maintenance: Never wash your HandiHaler® in water. If it is dirty, use a dry cloth to wipe it clean. If you need a new device, consult your doctor or pharmacist.

  • How to use the Spiriva® Respimat®

    1. Device setup: Insert the cartridge into the Respimat® inhaler. Turn the clear base toward the arrows on the label until it clicks (half a turn). Open the cap, then press the dose-release button. Repeat this process three more times to ensure the inhaler is ready for use.

    2. Click the base in place: Turn the clear base toward the white arrows on the label until it clicks (half a turn). Open the cap to expose the mouthpiece. Check that the mouthpiece is clean and dry.

    3. Exhale: Breathe out slowly and fully, and then close your lips around the end of the mouthpiece without covering the air vents. Tilt your head back slightly.

    4. Inhale: While taking a slow, deep breath through your mouth, press the dose-release button and continue breathing slowly. 

    5. Hold your breath: Hold your breath for 10 seconds or as long as comfortable, then exhale slowly.

    6. Close: Close the cap until you use your inhaler again.

    7. Storage: After use, keep the inhaler clean and dry. Store the inhaler with the cap closed. Keep track of the dose indicator on the side of the inhaler to know when the cartridge is nearly empty.

  • What do I do if I miss a dose of Spiriva®?

    It’s important to try to be consistent with Spiriva®. Taking your medication simultaneously every day helps keep a steady amount in your lungs to help manage your symptoms. Setting an alarm on your phone or alarm clock is a great way to help you stay consistent. 

    However, if you miss a Spiriva® dose and remember soon after the missed dose, take it as soon as you remember. 

    If it's almost time for your next dose, skip the missed dose. Don’t double up to make up for the missed dose, as this can increase your risk of side effects. Just resume your regular schedule.

  • Do I take Spiriva® in the morning or the night?

    Spiriva® (tiotropium) can be taken at any time of day; it's up to you to choose the most convenient time. This ensures a consistent level of the medication in your body, maximizing its effectiveness. Remembering to take your dose at around the same time daily is crucial. By doing so, you optimize the benefits of Spiriva® and can maintain a consistent medication routine.

  • Can I just stop taking Spiriva®?

    Only discontinue your medication or reduce the dosage after consulting your doctor. Abruptly stopping or lowering the dosage can make COPD symptoms worse, so it’s very important to talk to your doctor before making any changes to your medication plan.

  • Potential withdrawal symptoms: risks of stopping Spiriva® abruptly

    While Spiriva® is not known to cause withdrawal symptoms in the traditional sense (like those associated with opioids or benzodiazepines), suddenly stopping the medication can lead to a return or worsening of respiratory symptoms. This can include increased shortness of breath, wheezing, coughing, and a general decline in lung function. For individuals with COPD or asthma, these symptoms can significantly impact their quality of life and ability to carry out daily activities: 

    • Breathing problems worsened: The most immediate risk of suddenly stopping Spiriva® is that it gets harder to breathe when your airways get tighter. 

    • Severe flare-ups: Your maintenance medications like Spiriva® are prescribed to minimize flare-ups. If you stop taking it, you increase the risk of severe symptoms that may even require hospitalization. 

    • Decreased lung function: Ongoing use of Spiriva® is often crucial in maintaining lung function over time. Abruptly stopping the medication can lead to a decline in lung function, which may not be immediately reversible.

    • Complications in overall health: Any decline in respiratory function can adversely affect the overall health of patients with COPD, particularly those with severe forms. It can increase the risk of complications, including infections and heart problems.

    If you are considering stopping Spiriva®, it's strongly recommended that you consult your physician first. They can assess your current respiratory status and discuss the reasons for your decision. Sometimes, switching medications or adjusting dosage might be appropriate rather than stopping treatment altogether. Your doctor can also monitor your condition and guide you to ensure any transition is as safe and comfortable as possible.

Warnings and precautions

Be sure to talk to your doctor about any medications or supplements you are taking and any health conditions you have to limit any potential risks associated with taking Spiriva®.

  • Important drug interactions: what should I avoid while using Spiriva®?

    Several medications may interact with Spiriva®, including:

    • Anticholinergic medications: Combining Spiriva® with other anticholinergic medications may enhance the risk of side effects.

    • Beta-blockers: Beta-blockers can counteract the bronchodilator effects of Spiriva®, potentially reducing its efficacy.

    • Diuretics: Certain diuretics may lead to electrolyte imbalances when combined with Spiriva®.

    While moderate alcohol consumption may not directly interact with Spiriva®, excessive alcohol intake can exacerbate side effects like dizziness or drowsiness. Always limit alcohol intake and discuss your alcohol consumption with your healthcare provider.

  • Medications that may be used with Spiriva®

    Depending on your long-term treatment plan, your doctor may prescribe other medications that can be used together with Spiriva®, including:

    • Long-acting beta-agonists (LABAs) like salmeterol or formoterol are sometimes prescribed alongside Spiriva® to help open the lung airways further. 

    • Inhaled corticosteroids (ICS) like fluticasone or budesonide are commonly combined with Spiriva® to help reduce lung inflammation. 

    • Combination inhalers like Advair or Symbicort have both an LABA and an ICS. 

    Your doctor may also prescribe rescue inhalers like albuterol for quick relief when you suffer a COPD or asthma flare-up.

  • Contraindications: who should not take Spiriva®?

    Your doctor will help you decide if tiotropium is right for you. While this medication is generally well-tolerated, caution is advised for specific groups:

    • Pregnant and breastfeeding: The safety of Spiriva® during pregnancy and breastfeeding is not well-established. Consult with your doctor to weigh the potential risks and benefits.

    • Elderly: The elderly can generally use Spiriva® safely, but caution should be exercised, especially if pre-existing health conditions exist. It’s essential to regularly monitor and discuss any potential side effects with your doctor.

    • Children: Spiriva® is not typically prescribed for children as its pediatric safety and efficacy have not been established.

    • Narrow-angle glaucoma: Spiriva® can worsen narrow-angle glaucoma. If you have this condition, carefully monitoring and considering alternative treatments may be necessary.

    • Urinary retention issues: Spiriva® may exacerbate urinary retention; it’s important to closely monitor any worsening symptoms. 

    • Hypersensitivity reactions to atropine or its derivatives: Spiriva® should be avoided altogether in this case.

    Tell your doctor if you have, or have had, any of the following medical conditions:

    • High pressure in the eye (glaucoma)

    • Kidney/renal problems 

    • Liver problems

    • Problems with your prostate gland

    • Problems with passing urine

    • You have suffered from a heart attack during the last 6 months or from any unstable or life-threatening irregular heartbeat or severe heart failure within the past year

    Moderate to severe kidney problems can affect your body’s ability to eliminate the drug, making it important to regularly monitor kidney function. It’s important to have a thorough discussion with your doctor about the pros and cons of using Spiriva® in light of any medical conditions, ongoing treatments or medications, and health history.

  • Overdose symptoms

    The risk of overdose with Spiriva® inhaler (tiotropium) is generally low. Potential overdose symptoms include severe dry mouth, blurred vision, difficulty urinating, fast or irregular heart rate, and dizziness. If you notice any severe side effects or if you suspect an overdose, seek medical attention promptly.

    In case of accidental overdose, immediately contact your local poison control center or seek emergency medical attention. Provide relevant information about the medication, dosage, and any symptoms observed. If the individual is unconscious or having difficulty breathing, call emergency services immediately.

Spiriva® inhaler FAQs

  • Is there a steroid in Spiriva®?

    No, Spiriva® (tiotropium) is not a steroid. It belongs to a class of medications called anticholinergics, which work as bronchodilators to relax the muscles in the airways, helping with conditions like COPD or asthma.

  • Can you take Advair and Spiriva® together?

    Taking Advair (fluticasone/salmeterol) and tiotropium bromide together helps manage certain respiratory conditions. These medications serve different purposes—Advair is a combination inhaler containing a steroid and a long-acting beta-agonist, while Spiriva® is an anticholinergic bronchodilator. Combining them provides comprehensive relief for chronic obstructive pulmonary disease (COPD) or asthma. Deciding the best COPD treatment depends on your doctor’s diagnosis and treatment plan.

  • How long does it take for Spiriva® to work?

    Spiriva® may start working within 30 minutes to a few hours after the first dose. However, its full effects might take a few days to weeks of consistent use for optimal results.

  • Is Spiriva® a rescue inhaler?

    No, Spiriva® is not a rescue inhaler. It is a maintenance medication used regularly to manage chronic respiratory conditions like COPD or asthma, not for immediate relief during acute breathing problems.

  • Do you need a prescription for Spiriva® inhaler?

    Yes, Spiriva® is a prescription medication. It requires a doctor's prescription for purchase and use. Schedule an online doctor appointment to talk to a doctor about if Spiriva® is suitable for you.

  • Is tiotropium the same as Spiriva®?

    Tiotropium is the active ingredient in Spiriva®. Spiriva® is a brand-name medication containing tiotropium bromide as its active component.

  • Is there a generic substitute for Spiriva®?

    Yes, generic versions of tiotropium are available. They contain the same active ingredient as Spiriva® but may be sold under different brand names.

  • How long does Spiriva® last for?

    Spiriva® is usually taken once daily. Its effects can last for 24 hours, providing consistent relief from symptoms of respiratory conditions.

How to get Spiriva® online

Step 1

Book an appointment to discuss Spiriva®.

Book a same-day appointment from anywhere.

Step 2

Talk to your doctor about your asthma symptoms online.

Visit with a doctor on your smartphone or computer.

Step 3

Pick up your Spiriva® inhaler, if prescribed.

Prescriptions are provided at the doctor’s discretion. We can send prescriptions to any local pharmacy.

Spiriva® pricing details

To get a new or refill on your Spiriva® prescription, join our monthly membership.

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Visit price with insurance

Often the same as an office visit. Most patients with in-network insurance pay $30 or less!

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Paying without insurance



First month free



30 days of free membership

  • Same-day appointments 7 days a week

  • Unlimited messages with your Care Team

  • Prescription discount card to save up to 80%

  • Exclusive discounts on lab tests

  • Free memberships for your family

  • Cancel anytime

Visit price without insurance

Initial visits are $129.

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PlushCare is dedicated dxzto providing you with accurate and trustworthy health information.

  1. Centers for Disease Control and Prevention. Accessed on December 11, 2023 athttps://www.cdc.gov/copd/pdfs/fact_sheet-breathing_better_with_a_copd_diagnosis.pdf

  2. PubMed Central. "Questionnaire on switching from the tiotropium HandiHaler® to the Respimat® inhaler in patients with chronic obstructive pulmonary disease: changes in handling and preferences immediately and several years after the switch." Accessed on December 11, 2023, at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293296/.

  3. National Library of Medicine. Accessed on December 11, 2023 at https://www.ncbi.nlm.nih.gov/books/

  4. National Library of Medicine. Accessed on December 11, 2023 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263162/

  5. NPS MedicineWise. “Spiriva® Respimat®” Accessed on December 11, 2023 at https://www.nps.org.au/medicine-finder/Spiriva®-Respimat®-solution-for-inhalation

PlushCare content is reviewed by MDs, PhDs, NPs, nutritionists, and other healthcare professionals. Learn more about our editorial standards and meet the medical team. The PlushCare site or any linked materials are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment.