Spiriva is a popular and effective medication used in the treatment of COPD. It is administered as a powder, and is inhaled using a HandiHaler. It is intended for long-term use, and has been shown to be very effective in improving quality of life, reducing symptoms, and extending lives. How does it work?
To understand the mechanism by which Spiriva works, a review of certain anatomical facts is required. The body contains several types of muscle tissue. Skeletal muscle is familiar to us as the muscles which move our limbs. Smooth muscle is found in organs, blood vessels, and the larger passages of the lungs. It is the contraction of these passages in the lungs, known as bronchial passages, that produces the sensation of constriction felt by COPD sufferers. Muscles can't contract by themselves. Even muscles that cannot be voluntarily contracted require a signal from the nervous system in order to work. The agent of this contraction is a molecule known as acetylcholine. Acetylcholine is a neurotransmitter; it acts on receptors in the muscles to cause contraction.
There are several different types of receptors in muscle tissue. The receptors in smooth muscle tissue that react to acetylcholine are called M3 receptors. They react to a specific type of acetylcholine, in a very specific way, to produce muscle contraction. Tiotropium, the active ingredient in Spiriva, is an acetylcholine antagonist. It binds to the receptor sites and prevents them from reacting to the neurotransmitters. This produces, over the the long term, a more relaxed bronchial passage. It should be noted that the use of tiotropium must be regular and continuous in order to produce the desired effect. It cannot be used as a rescue inhaler, and is normally used in conjunction with a beta-2 agonist and a corticosteroid. Although tiotropium does not produce the sudden and noticeable effect of a rescue inhaler, studies have proven it effective in the long-term treatment of COPD.
It is important to note that COPD, in almost all cases, is caused by smoking. The patient must discontinue smoking while using Spiriva. Nicotine from the smoke acts as a neurotransmitter, and can bond to the same M3 sites that Spiriva is aimed at. Smoking while taking Spiriva will almost completely nullify the drug's positive effects, as the nicotine prevents the tiotropium from bonding to the M3 receptors and doing its job.
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