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Spiriva alternatives: What can I take instead of Spiriva Respimat?

COPD and asthma treatment options if Spiriva isn’t right for you
By | Updated on Oct. 6, 2025 Medically reviewed by Karen Berger, Pharm.D.

Key takeaways

  • Spiriva Respimat alternatives for asthma or chronic obstructive pulmonary disease (COPD) include Incruse Ellipta, Anoro Ellipta, Breo Ellipta, Trelegy Ellipta, and Symbicort, among others.

  • These alternatives may contain different drug classes, such as LAMAs, LABAs, or ICS combinations, and they have differences in their FDA-approved uses, dosing, and side effects.

  • Switching from Spiriva Respimat to an alternative requires consultation with a healthcare provider to discuss concerns, review options, and ensure a safe transition.

In this article:

Spiriva Respimat is a brand-name medication that delivers tiotropium to airways via a soft mist inhaler. This medicine is classified as a long-acting antimuscarinic agent (LAMA) and works by relaxing the muscles in the airways of the lungs to make breathing easier. The resultant dilation of airways is welcomed by many users with asthma or chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. Unfortunately, Spiriva Respimat may not be the best option for everyone. If your symptoms aren’t improving, or you feel that any benefits are being offset by adverse effects, your healthcare provider may recommend a Spiriva alternative. 

What can I take in place of Spiriva Respimat?

There are various options you can try if Spiriva Respimat is not the best choice for you. In past years, treatment often started with a rescue inhaler (such as albuterol), and that’s still common for COPD. However, for asthma, the Global Initiative for Asthma (GINA) now recommends starting with an inhaled corticosteroid (ICS) as a maintenance treatment, sometimes in combination with a long-acting bronchodilator if needed. Still, treatment plans can vary based on individual factors like frequency and severity of symptoms, other health conditions, and the medications you take—so be sure to consult your healthcare provider for personalized medical advice.

Top 5 Spiriva Respimat alternatives

The following are some of the most common alternatives to Spiriva Respimat.

1. Incruse Ellipta

LAMAs are a common choice for treatment in COPD patients. The convenience of a once-daily LAMA, like Incruse Ellipta or Spiriva Respimat, is hard to beat. Incruse Ellipta offers a different delivery mechanism compared to Spiriva Respimat’s mist inhaler. As a dry inhalation powder, Incruse Ellipta requires one deep, quick inhalation to effectively deliver the medication to the lungs. Many users find dry powder inhalers easier to use because they do not have to coordinate activation of the device with the timing of an inhalation. Incruse Ellipta is approved by the U.S. Food and Drug Administration (FDA) for maintenance treatment of COPD, but is not FDA-approved for asthma. Note that severe milk protein allergy is a contraindication to Incruse Ellipta and other dry powder inhalers.

RELATED: Incruse Ellipta vs. Spiriva

2. Anoro Ellipta

A LAMA alone may be insufficient to control your asthma or COPD symptoms. Anoro Ellipta is a combination inhaler that offers a broader intervention. It combines two types of bronchodilating medications, coupling a LAMA (umeclidinium) with a long-acting beta-agonist, or LABA, vilanterol. Anoro Ellipta is FDA-approved for maintenance treatment of COPD. You may feel that the dual action is more effective. On the contrary, adding more medication could lead to more side effects, too. For example, the LABA content can lead to increases in blood pressure and heart rate, and the LAMA content could lead to dry mouth, difficulty urinating, or worsening glaucoma.

RELATED: Anoro Ellipta alternatives

3. Breo Ellipta

Breo Ellipta is a dry powder inhaler that combines the LABA vilanterol and an ICS fluticasone furoate to produce bronchodilation and reduced airway inflammation. Breo Ellipta is FDA-approved for maintenance treatment in people with asthma (adults and children 5 years and older) or COPD. Breo is typically used once per day. Because of the ICS component, there is a risk of thrush (yeast infection of the mouth and throat)—it’s important to always rinse your mouth thoroughly after using.

RELATED: Breo Ellipta side effects and how to avoid them

4. Trelegy Ellipta

Trelegy Ellipta is a once-daily inhaler that contains three active ingredients: fluticasone furoate (an ICS), umeclidinium (an anticholinergic), and vilanterol (a LABA). It is FDA-approved for maintenance treatment of asthma and COPD in adults. It is not approved for use in pediatric patients. 

Trelegy represents a step up in therapy for those inadequately helped by dual mechanism inhalers. With three active ingredients, there can be more side effects and drug interactions to consider. Your healthcare provider can determine if this medicine would be appropriate for you.

5. Symbicort

Symbicort is an inhaler that contains budesonide (an ICS) and formoterol fumarate dihydrate (a LABA). It is FDA-approved for maintenance treatment of COPD. Symbicort is also used in adults and children six years and older to treat asthma. Some of the common side effects include throat irritation, oral thrush, sinus infections, and upper respiratory tract infections. Symbicort is typically used twice a day. 

Compare Spiriva to alternatives
Drug name Uses Dosage Savings options
Spiriva Respimat (tiotropium bromide) COPD maintenance, asthma maintenance COPD: 2.5 mcg per actuation, 2 puffs inhaled once daily

Asthma: 1.25 mcg per actuation, 2 puffs inhaled once daily

 Spiriva Respimat coupons
Spiriva Handihaler (tiotropium bromide) COPD maintenance 18 mcg inhaled once daily Spiriva Handihaler coupons
Incruse Ellipta (umeclidinium) COPD maintenance 62.5 mcg per actuation, 1 puff inhaled once daily Incruse Ellipta coupons
Anoro Ellipta (umeclidinium–vilanterol) COPD maintenance 62.5 mcg/25 mcg per actuation, 1 puff inhaled once daily Anoro Ellipta coupons
Breo Ellipta (fluticasone furoate-vilanterol) COPD maintenance, asthma maintenance COPD: 100 mcg/25 mcg per actuation, 1 puff inhaled daily

Asthma: 100 mcg/25 mcg or 200 mcg/25 mcg per actuation, 1 puff inhaled daily

 Breo Ellipta coupons
Trelegy Ellipta (fluticasone–umeclidinium–vilanterol) COPD maintenance, asthma maintenance COPD: 100 mcg/62.5 mcg/25 mcg per actuation, 1 puff inhaled once daily

Asthma: 100 mcg/62.5 mcg/25 mcg or 200 mcg/62.5 mcg/25 mcg per actuation, 1 puff inhaled once daily

 Trelegy Ellipta coupons
Symbicort (budesonide–formoterol) COPD maintenance, asthma maintenance, single inhaler maintenance, and reliever therapy for persistent asthma (off-label) COPD: 160 mcg/4.5 mcg per actuation, 2 puffs twice daily

Asthma maintenance: 80 mcg/4.5 mcg or 160 mcg/4.5 mcg per actuation, 2 puffs twice daily

Asthma (persistent): 1 or 2 puffs inhaled once or twice daily, then 1 or 2 puffs inhaled every 4 hours as needed

 Symbicort coupons
Stiolto Respimat (olodaterol-tiotropium) COPD maintenance 2.5 mcg/2.5 mcg per actuation, 2 puffs inhaled once daily Stiolto Respimat coupons
Tudorza Pressair (aclidinium) COPD maintenance 400 mcg per actuation, 1 puff inhaled every 12 hours Tudorza Pressair coupons
Duaklir Pressair (aclidinium–formoterol) COPD maintenance 400 mcg/12 mcg per actuation, 1 puff inhaled every 12 hours Duaklir Pressair coupons
Combivent Respimat (ipratropium-albuterol) COPD, asthma exacerbation relief (off-label) 20 mcg/100 mcg per actuation, 1 puff inhaled four times daily Combivent Respimat coupons
Advair Diskus (fluticasone-salmeterol) COPD maintenance, asthma maintenance COPD: 250 mcg/50 mcg per actuation, 1 puff inhaled every 12 hours Advair Diskus coupons
Daliresp (roflumilast) Severe COPD  250 mcg orally once daily for four weeks, then 500 mcg orally once daily Daliresp coupons
Theophylline ER COPD maintenance, asthma maintenance 300 to 600 mg orally once daily Theophylline ER coupons

 

Natural alternatives to Spiriva Respimat

Hearing the advantages and disadvantages of alternatives to Spiriva Respimat can be overwhelming. While there are some non-pharmacologic options that may provide symptom relief, you may still need to take medication, so be sure to talk with your healthcare provider before you stop taking it.

If you smoke, quitting is the best way to reduce the severity of asthma symptoms and slow down the deterioration in lung function in COPD. Consider the prescription aids for smoking cessation, such as varenicline, Nicoderm CQ, or bupropion SR, to increase the chance of successfully quitting. 

Pulmonary rehabilitation is exercise therapy tailored for COPD. It is a proven option for improving quality of life and exercise capacity. The rehab sessions can be a nice springboard to starting a daily exercise routine. Asthma symptom control and quality of life improvements are possible with weight management. 

Nutrient supplementation is not a proven remedy yet, but that does not mean that nutrients are not important. Low levels of vitamin D, zinc, potassium, magnesium, and selenium have been associated with higher COPD risk. There are just no clinical trial results to show a benefit from supplementing these nutrients. 

Before embarking on a weight loss effort, exercise campaign, or dietary supplement, check with your healthcare provider to see if it is safe for you.

COPD Coupons & Resources

How to switch to a Spiriva Respimat alternative

If you’re considering switching from Spiriva to an alternative, make an appointment with your healthcare provider. You can present your concerns about Spiriva Respimat and review your ideas about alternatives. Be prepared with your list of any prescription medications, over-the-counter drugs, and supplements you’re currently taking so your provider can recommend an option that’s safe and effective. 

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