Tiotropium

INTRODUCTION

Indications

Long-term maintenance treatment of bronchospasm due to COPD.

Action

Acts an anticholinergic by selectively and reversibly inhibiting M₃ receptors in smooth muscle of airways. Therapeutic Effects: ↓ incidence and severity of bronchospasm.

Adverse Reactions/Side Effects

EENT: glaucoma. Resp: paradoxical bronchospasm. CV: ↑ heart rate. GI: dry mouth, constipation. GU: urinary difficulty, urinary retention. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANGIOEDEMA.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of hypersensitivity reactions and angioedema, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria, swelling in the face). Notify physician immediately if these reactions occur.

• Assess pulmonary function at rest and during exercise (See Appendices I, J, K) to document effectiveness of medication in controlling bronchospasm in COPD.

• Monitor signs of paradoxical bronchospasm (wheezing, cough, dyspnea, tightness in chest and throat), especially at higher or excessive doses. If condition occurs, advise patient to withhold medication and notify physician immediately.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Monitor and report any vision disturbances that might indicate glaucoma, such as blurred vision, tunnel vision, halos around lights, and so forth.

Interventions

• Design and implement appropriate aerobic exercise and respiratory muscle training programs to maintain optimal cardiovascular and pulmonary function. Work with patient and family/caregivers to find forms of exercise (e.g., swimming) that can help improve respiratory function without triggering bronchoconstrictive attacks.

• When implementing airway clearance techniques or respiratory muscle training, attempt to intervene when the airway is maximally bronchodilated. Peak responses typically occur 5 min after inhalation.

Patient/Client-Related Instruction

• Advise patient to not exceed the recommended dose or frequency of inhalations. Contact physician immediately if bronchospasm is not relieved by medication or is accompanied by diaphoresis, dizziness, or other symptoms.

• Counsel patient on proper use of inhaler; observe use of this device whenever possible to ensure proper technique.

• Instruct patient and family/caregivers to report troublesome side effects such as severe or prolonged problems with urination or GI problems (constipation, dry mouth).

Pharmacokinetics

Absorption: 19.5% absorbed following inhalation.

Distribution: Extensive tissue distribution; due to route of administration, ↑ concentrations occur in lung.

Metabolism and Excretion: 74% excreted unchanged in urine; 25% of absorbed drug is metabolized.

Half-life: 5–6 days.