This document summarizes information about the mode of action of SPIRIVA Respimat for treating asthma. It explains that SPIRIVA is an anticholinergic that works by binding to M3 receptors for over 24 hours to antagonize the effects of acetylcholine, resulting in bronchodilation by reducing smooth muscle contraction, mucus secretion, and inflammation. By blocking acetylcholine's stimulation of M3 receptors on airway smooth muscle, submucosal glands, and inflammatory cells, SPIRIVA treats bronchoconstriction and is approved in some countries for adult asthma patients who experienced severe exacerbations while treated with other medications.

1. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
Mode of Action

2. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
This information is from an international website which is intended for healthcare
professionals not located in the United States of America (US) and the United Kingdom (UK).
SPIRIVA® Respimat® (tiotropium) is subject to country-specific regulations and the approved
product label may vary from country to country. Information on this website is derived from
the approved European Summary of Product Characteristics. Please refer to your local
product label for full details.
©Boehringer Ingelheim International GmbH 2017. This document and its contents are
property of Boehringer Ingelheim (third party sources are indicated) and are, inter alia,
protected by copyright law. Complete or partial passing on to third parties as well as
copying, reproduction, publication or any other use by third parties is not permitted.

3. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
This short animated video shows the mode of
action (MoA) of SPIRIVA® Respimat® (tiotropium)
in the treatment of asthma.
Binding to M3 receptors, SPIRIVA® Respimat® blocks acetylcholine, which plays a significant
role in the pathophysiology of asthma, and antagonises the bronchoconstrictive effects,
resulting in bronchial smooth muscle relaxation.

4. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
Acetylcholine is the primary
parasympathetic neuro-transmitter in the
airways and plays a significant role in the
pathophysiology of asthma1.
Mode of Action

5. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
When released acetylcholine
Mode of Action

6. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
stimulates muscarinic M3 receptors
Mode of Action

7. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
on airway smooth muscle2,
Mode of Action

8. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
On submucosal glands,2
Mode of Action

9. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
And on inflammatory cells3
Mode of Action

10. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
In asthma patient’s activation of M3
receptors by acetylcholine leads to smooth
muscle contraction4,5
Mode of Action

11. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
resulting in bronchoconstriction,3
Mode of Action

12. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
with mucus secretion into the airway
lumen,4 and mucus over secretion4
Mode of Action

13. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
and inflammatory cell activation5which
contributes to airway inflammation4,5 and
remodelling in asthma animal models4,5
Mode of Action

14. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
Mode of Action

15. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
SPIRIVA® (tiotropium) Respimat® is an
anticholinergic6
and binds to the M3 receptors, for more
than 24 hours, antagonising the effects of
acetylcholine1,2,3,5
Mode of Action

16. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
resulting in increased airflow3
Mode of Action

17. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
reducing mucus secretion1,2
and may have effects in airway remodeling
and inflammation1,4
Mode of Action

18. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
SPIRIVA® Respimat®, approved for asthma.6
Mode of Action

19. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
References
1. Moulton BC and Fryer AD, Br J Pharmacol. 2011; 163(1): 44–52
2. Kistemaker LEM, et al. Trends Pharmacol Sci 2015; 36:3, 164–171
3. Buels KS and Fryer AD Handb Exp Pharmacol. 2012; (208): 317-341
4. Kistemaker LEM, et al. Life Sci 2012;91:1126–1133
5. Gosens R, et al. Respir Res 2006;7:73
6. Summary of Product Characteristics. SPIRIVA Respimat®. 13 Jan 2017

20. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
Spiriva Respimat 2.5 microgram, inhalation solution Active substance: tiotropium bromide
Qualitative and quantitative composition: The delivered dose is 2.5 microgram tiotropium per
puff (2 puffs comprise one medicinal dose). List of excipients: benzalkonium chloride;
disodium edetate; water, purified; 1M hydrochloric acid (for pH adjustment) Indication: Spiriva
Respimat is indicated as an add-on maintenance bronchodilator treatment in adult patients
with asthma who are currently treated with the maintenance combination of inhaled
corticosteroids (≥800 µg budesonide/day or equivalent) and long-acting ß2 agonists and who
experienced one or more severe exacerbations in the previous year. Contraindications:
Hypersensitivity to tiotropium bromide or to any of the excipients listed above or to atropine
or its derivatives, e.g. ipratropium or oxitropium. Undesirable effects: Common: dry mouth.
Uncommon: dizziness; headache; insomnia; palpitations; cough; pharyngitis; dysphonia;
bronchospasm; oropharyngeal candidiasis. Rare: constipation; gingivitis; stomatitis; rash;
pruritus; angioneurotic oedema; urticaria; hypersensitivity (including immediate reactions).
Not known: dehydration; glaucoma; intraocular pressure increased; vission blurred; aterial
fibrillation; supraventricular tachycardia; tachycardia; epistaxix; laryngitis; sinusitis; dysphagia;
gastrooesophageal reflux disease; dental caries; glossitis; intestinal obstruction, including ileus
paralytic; nausea; skin infection/skin ulcer; dry skin; anaphylactic reaction; joint swelling;
urinary retention; dysuria; urinary tract infection.
Medicinal product subject to medical prescription. Marketing Authorisation Holder:
Boehringer Ingelheim Pharma GmbH & Co. KG, Binger Strasse 173, D-55216 Ingelheim am
Rhein, Germany. Date of revision of text: 13 Jan 2017

21. Downloaded from www.spirivaglobal.com/asthma. This website and the presentation are intended for healthcare
professionals not located in the United States of America and the United Kingdom
For more information visit:
www.spirivaglobal.com/asthma