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The frequency of corresponding reactions in the ipratropium-controlled trials is included for comparison.

Clean the HandiHaler device one time each month or as needed.

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The safety and efficacy of SPIRIVA RESPIMAT have not been established in pediatric patients less than 12 years of age.

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Inhalation Spray if you are allergic to tiotropium, ipratropium, atropine or similar drugs, or any ingredient in this medicine.

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When compared with current treatment for chronic obstructive pulmonary disease, tiotropium is at least as effective as salmeterol and more effective than ipratropium; moreover, the once-a-day dosing increases the likelihood of patient compliance.

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Of the three types of devices used to deliver bronchodilators - nebulizers, metered-dose inhalers, and dry powder inhalers - nebulizers require no special technique or coordination, as the medication is converted into a fine mist that the patient inhales through a mouthpiece or face-mask while breathing naturally.

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Spiriva consists of two products, tiotropium bromide, a dry, white powder for treating chronic obstructive pulmonary diseases (COPD) such as emphysema and chronic bronchitis, and an inhaler device to deliver the medication (Spiriva HandiHaler).

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If you do not understand the instructions or have questions about using the inhaler, talk to your doctor.

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In common with other inhaled drugs, the majority of the delivered dose is deposited in the gastrointestinal tract and, to a lesser extent, in the lung, the intended organ.

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