Stiolto Respimat and Spiriva are not the same medication. They share one active ingredient, tiotropium, but Stiolto Respimat is a combination inhaler that adds a second drug called olodaterol. Think of it this way: Spiriva contains one bronchodilator, while Stiolto contains that same bronchodilator plus another one that works through a different mechanism. Both treat COPD, both are once-daily inhalers, and both use the same Respimat soft mist device, which is why they’re easy to confuse.
What Each Inhaler Contains
Spiriva delivers 5 mcg of tiotropium per dose (two puffs of 2.5 mcg each). Tiotropium is a long-acting muscarinic antagonist, meaning it relaxes the muscles around your airways by blocking a specific nerve signal that causes them to tighten. It was first approved as a dry powder capsule inhaler (the HandiHaler) in 2004, then as a soft mist spray (the Respimat) in 2014.
Stiolto Respimat delivers that same 5 mcg of tiotropium plus 5 mcg of olodaterol in each dose. Olodaterol is a long-acting beta-agonist (LABA), a different type of bronchodilator that relaxes airway muscles through a separate pathway. The FDA approved this combination in May 2015 for patients who need more airway opening than tiotropium alone provides.
Different Conditions, Different Approvals
Spiriva is approved for both COPD and asthma (including in children ages 6 and up). Stiolto Respimat is approved only for COPD, which includes chronic bronchitis and emphysema. The FDA label explicitly states that Stiolto is not indicated for asthma and that using its LABA component without an inhaled corticosteroid is actually contraindicated in asthma patients. This is because long-acting beta-agonists carry a safety concern for severe asthma flare-ups and asthma-related deaths when used without a steroid, a risk that does not appear to apply in COPD.
Neither inhaler is meant for sudden breathing emergencies. Both are maintenance treatments you use daily to keep airways open over time.
How the Combination Performs vs. Spiriva Alone
Two large clinical trials directly compared Stiolto’s combination to each of its ingredients used separately. After 24 weeks, patients using the combination showed meaningfully better lung function than those on tiotropium alone. In the first trial, Stiolto improved the amount of air patients could forcefully exhale in one second (a standard lung function measure) by 256 mL from baseline, compared to 139 mL for tiotropium alone. The second trial showed similar results: 268 mL for the combination versus 165 mL for tiotropium.
The difference translates to roughly 100 to 120 mL of additional airflow. That may sound small in absolute terms, but for someone with COPD whose airways are already significantly narrowed, that extra capacity can make daily activities like climbing stairs or walking across a parking lot noticeably easier.
Side Effects to Know About
Because Stiolto contains everything in Spiriva plus an additional drug, it carries all of Spiriva’s potential side effects along with some extras from the olodaterol component. The LABA portion can stimulate the cardiovascular system, so it may increase heart rate or affect heart rhythm in some people. It can also lower potassium levels and raise blood sugar, effects that are worth watching if you take diuretics, steroids, or certain other medications.
Spiriva’s side effects are primarily related to its anticholinergic action: dry mouth, constipation, and urinary retention are the most commonly reported. Stiolto shares these. If you’re switching from Spiriva to Stiolto, the tiotropium-related side effects you’ve already experienced (or haven’t) will likely stay the same, but you may notice new effects from the added bronchodilator.
The Inhaler Device Is Identical
Both Stiolto Respimat and Spiriva Respimat use the same propellant-free soft mist inhaler. You twist the base to load a dose, then press a button to release a slow-moving mist over about 1.5 seconds. This design deposits a high fraction of fine particles deep into the lungs, more so than many traditional inhalers. The dosing routine is also the same: two puffs, once a day, at the same time each day.
Spiriva also comes as the HandiHaler, a dry powder device where you load a capsule, pierce it, and inhale the powder using your own breath to pull the drug out. Stiolto does not come in a HandiHaler version.
Generic Availability
As of now, no generic version of Stiolto Respimat is available. The FDA has issued draft guidance to manufacturers on how to demonstrate bioequivalence for a generic version of the tiotropium/olodaterol combination spray, which is a necessary step before any generic can reach the market. Generic tiotropium dry powder capsules (for use with generic HandiHaler-type devices) have become available, but a generic Respimat soft mist version of either product has not yet launched.
Which One You Might Use
If your COPD is well controlled on Spiriva alone, there’s no automatic reason to switch to Stiolto. The combination is typically considered when a single bronchodilator isn’t providing enough relief. Your prescriber may move you to Stiolto if you’re still experiencing significant shortness of breath or airflow limitation on tiotropium by itself. Because Stiolto includes everything Spiriva does, you should never use both at the same time, as that would double the tiotropium dose.
If you have asthma rather than COPD, Stiolto is not an option. Spiriva Respimat is the appropriate choice from this family of inhalers for asthma maintenance.