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Is Spiriva Safe To Take When Diagnosed With Mitral Valve Prolapse?

Posted on Sat, 18 Jun 2016

Question: Hello,
My doctor has prescribed me Spiriva Respimat to try as after 2 years of using Seretide there was very little improvement and Ventolin did more. I read the list of side effects of Spiriva and it scares me as I have a left mitral valve prolapse (see reference of warning below). I was wondering how common is Spiriva an issue for people?
https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2011/vol-124-no-1337/letter-ram

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
No need to worry for Spiriva use.

Detailed Answer:
Thanks for your question on Healthcare Magic.
I can understand your concern.
Spiriva is having tiotropium.
It is long acting muscarinic antagonist (LAMA).
It is best treatment for COPD.
And it is very safe in cardiac patients.
So no need to worry even of you are having mitral valve prolapse.
You can use this.
Now a days newer ultra long acting inhalers for COPD are available.
Drugs like indacaterol, glycopyrollium can be tried in your case.
Hope I have solved your query.
I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (27 hours later)

Thank you for your reply, can you please address the 40-50% increase in morality of people using Spiriva? I participate on a number of asthma forums and people are talking about these articles regarding Spiriva...

http://news.bbc.co.uk/2/hi/health/0000.stm
http://www.bbc.com/news/health-0000
http://www.gponline.com/anticholinergic-inhalers-raise-risk-cvd-58/article/848352
http://www.bmj.com/content/342/bmj.d2970.full?sid=23498e70-84bc-4839-a9f9-e1d0000e0

Are these articles incorrect?

Thank you in advance for you help.

Answered by Dr. Drkaushal85 (8 minutes later)

Brief Answer:
These are not correct.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
I have gone through the links you're have sent.
These studies clearly state that 'anyone with COPD who is benefiting from taking anticholinergic inhalers should not stop taking them based on this study alone'.
Believe me, I use this Spiriva in my daily clinical practice in at least 3-5 patients per day (average). I am not getting any serious cardiac side effects till date.i am practicing since 6 years.
So no need to worry for underlying mitral valve prolapse.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (59 minutes later)

Thank you again for your reply. Is Spiriva a LAMA/LABA? I remember you saying a LAMA/LABA is a good medication and my pulmonary nurse said the same. I am hoping Spiriva is a LAMA/LABA.

Regards

Answered by Dr. Drkaushal85 (8 minutes later)

Brief Answer:
Spiriva is having LAMA.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Spiriva is having tiotropium. It is LAMA.
Please let me know
1. Your weight
2. What was the prescribed dose by your nurse?
3. Do you have Spiriva 9 micrograms or 18 micrograms?
Please reply me answers of above asked questions, so that I can guide you about exact dosing to prevent side effects.
I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (8 minutes later)

Hello again,

I am prescribed Spiriva Respimat 2.5 micrograms. 2 doses by mouth daily for Asthma and Bronchiectasis. I was on Seretide but it didn't improve lung function very much after using it for 2 years. I read Spiriva is not for Asthma? Have you prescribed it for Asthma patients with good success?

Regards

Answered by Dr. Drkaushal85 (8 minutes later)

Brief Answer:
Yes, Spiriva is not much effective in asthma.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Yes, you are right. Spiriva is not much effective in asthma.
But in later stages of asthma where irreversible lung damage is there, asthma behaves like COPD. And in such cases Spiriva can be used.
Like I said above, I use Spiriva in long standing asthma patients, not in regular asthma patients.
If you permit, I want to ask few more questions about your disease which definitely help you.
I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (49 minutes later)

Hello again,

I have had asthma since very young. My pulmonary specialist says I have lung remodeling and a lung capacity of about 60%. My regular doctor was not happy for me to stay on Seretide and feels Spiriva will work better for my condition as using Ventolin works more than Seretide. I hope t his information gives you some insight into my situation and I hope Spiriva may be what I need.

Answered by Dr. Drkaushal85 (6 minutes later)

Brief Answer:
What about bronchiectesis part?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Asthma with bronchiectesis is not so common.
Possibility of ABPA (allergic broncho pulmonary aspergillosis) can be the cause.
This is the common cause for uncontrolled asthma.
So please let me know
1. Have you ever had CT scan?
2. Do you have central bronchiectesis?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Drkaushal85 (15 minutes later)

Hello,

I have lower left lobe bronchiectasis with some suspected lower right lobe (minor).

I had CT scans in 2014 when I had severe hemoptysis and suspected TB. No definite cause was determined but suspected infection so IV anti-biotics was administered for one week. My lung function dropped to 47% but improved over the past few years to 60%.

I attend lung rehab at hospital each week on Tuesday. My SpO2 is around 97% sitting and 95% after an hours gym/rehab workout. Sometimes lower at 94% in winter.

I suspect my asthma come from my mother smoking heaving around me as a baby and child until I was 16 years old. She smoked 2-3 packets a day.

Interestingly I do find relief from Asthma using antihistamines (and Ventolin).

Thanks you for your help.

Answered by Dr. Drkaushal85 (53 minutes later)

Brief Answer:
Combination of anti allergic and anti histamine drugs are also beneficial.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
In my opinion, you should start ultra LABA (indacaterol), ultra LAMA (glycopyrollium) and long acting inhaled corticosteroids (ICS) (fluticasone or budesonide).
Combination of all these three are excellent for asthma control.
Along with inhalers, oral combination of antihistamine (levocetrizine or fexofenadine) and anti allergic (montelukast) drugs will also beneficial in your case.
Since you are having bronchiectesis, proper management of this is also needed to control asthma and improves lung functions.
So please let me know
1. Are you taking anything for bronchiectesis?
2. Are you taking anti oxidant like N acetyl cysteine (NAC)?
3. Are you taking pulmonary vaccines regularly?
See, all these factors are important in your case.
So please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar