Tiotropium with olodaterol

How it works

Tiotropium blocks muscarinic receptors to reduce cholinergic bronchoconstriction, while olodaterol stimulates beta-2 adrenoceptors to relax airway smooth muscle, giving complementary sustained bronchodilatation.

Prescribing in practice

• Avoid the tiotropium component in closed-angle glaucoma and use cautiously in significant bladder-outflow obstruction or prostatic disease because of antimuscarinic effects.
• The olodaterol LABA component warrants caution in cardiovascular disease, arrhythmias and hyperthyroidism, with additive hypokalaemia risk alongside steroids and diuretics.
• It is for regular maintenance only and a separate short-acting bronchodilator should be supplied for acute breathlessness.

Monitoring

Monitor inhaler technique, symptom control and exacerbation frequency, with attention to antimuscarinic side effects and cardiovascular tolerability.

Counselling the patient

• Take it at the same time each day for prevention; it will not relieve a sudden attack.
• Report eye pain or visual halos, or difficulty passing urine, promptly.

Evidence & guidelines

Fixed LAMA/LABA combinations like this are supported by COPD trials and NICE guidance showing improved lung function and symptoms over single bronchodilators.