Spiriva respimat

I've been on spiriva respimat for now 3 years. I have a fungal infection also so I must avoid steroids. I can't say I have any side effects. I get to skip a dose next Monday for an SSD PFT.

thanks rick, do you bring an albuterol inhaler with you for your pfts? this asthma/cops just snuck up on me this year. The doc said my pfts showed small copd last fall. then this spring started with chest tightness and coughing (thus the albuterol). After 6 years of known bronchiectasis didn’t realize this came along with it.

Hmm, I think I heard something about that, so I did some looking and you are correct. That is why, at least in the US all LABA's have an added steroid. In my case, the Breyna inhaler (generic Symbicort) includes 80 mcg of budosenide and 4.5 mcg of formoterol. Other dosages are available.

LAMA agents do 2 things, relax the airways, and reducing excess mucus production. There have been few objective studies as yet, but additional research may be verified based on this small observational study:
https://pubmed.ncbi.nlm.nih.gov/33569197
Remember, reducing excess mucus production doesn't necessarily mean totally drying it up. There are many people here who would welcome any reduction in the copious amounts of mucus they produce.
Sue

National Jewish Health supports the selective use combination inhalers in the treatment of Bronchiectasis. ( https://www.nationaljewish.org/conditions/bronchiectasis/bronchiectasis-
overview/treatment )

Many organizations here and in Europe are suggesting that empirical studies of all bronchodilator use in Bronchiectasis be researched further, and that use may not be justified unless a person has underlying asthma or obstructed airways.
https://www.archbronconeumol.org/en-dual-broncodilator-triple-therapy-in-articulo-S0300289623002284 (and others.)

Sue, I really hate to disagree with you, but I don’t believe all LABA’s have a steroid in them. I know of least 4 that are LABA’s & LAMA’s, Anoro, Bevespi, Stilton, Utibron. Yes they are combination meds, but contain no corticosteroid. Maybe you can help me understand what criteria a Dr. uses to prescribe a specific inhaler! For 3-4 years now I’ve experienced excessive mucus. My Pulmonologists always prescribed a LABA & LAMA combination inhaler. Never an inhaler with a corticosteroid in it. Now I do understand the effects and dangers of steroids, but they are supposed to help with inflammation, which in turn should decrease mucus production I believe. Maybe because I’m already on Cellcept which is an immunosuppressant. Any insight?

Spider, did you mean Stiolto vs Stilton? Is Utibron available in the US? I researching for Medicare part D coverages for next year.

Sue, I really hate to disagree with you, but I don’t believe all LABA’s have a steroid in them. I know of least 4 that are LABA’s & LAMA’s, Anoro, Bevespi, Stilton, Utibron. Yes they are combination meds, but contain no corticosteroid. Maybe you can help me understand what criteria a Dr. uses to prescribe a specific inhaler! For 3-4 years now I’ve experienced excessive mucus. My Pulmonologists always prescribed a LABA & LAMA combination inhaler. Never an inhaler with a corticosteroid in it. Now I do understand the effects and dangers of steroids, but they are supposed to help with inflammation, which in turn should decrease mucus production I believe. Maybe because I’m already on Cellcept which is an immunosuppressant. Any insight?

For anyone taking Spiriva, any tips on not coughing as soon as the medicine dispenses? This one almost always makes me cough. I use this one in the morning, followed by Breyna, plus albuterol as needed. I then Nebulize and use my vest. I had been combining nebbing with the vest but see that Dr McShane doesn’t recommend doing them together as the compression may not allow all the saline to get into your lungs.

Wow - any explanation as to why the doctor has you using two separate long-acting beta-agonists - that is what Spiriva and Breyna are. Is it possible they were prescribed by different docs, or one was started first and just not discontinued when they started the other?

Do you have asthma or COPD as well as bronchiectasis?

I didn't know the profile of both inhalers so appreciate you sharing that info. I’m absorbing so much information here about this process and treatments. Both inhalers were prescribed by my pulmonologist following my latest PFT. I started on BREYNA but then they added in the Spiriva at the next follow up. I did ask about the exact question you posed, does Spiriva replace the BREYNA, but even in my MyChart summary it’s lists taking them both. The PFT showed my results improved after using an inhaler so with the suspected asthma component and continued shortness of breath this was the recommended therapy. I do go back in October so will certainly ask. I believe they did say there is an inhaler with is a combination so you don’t need multiple ones?