Stiolto Respimat is a once-daily maintenance inhaler for COPD that delivers two puffs of medication through a slow-mist spray. The device uses a unique twist-and-press mechanism rather than the pressurized burst of a traditional inhaler, which means the technique differs from what you may be used to. Here’s how to set it up, use it correctly, and keep it working properly.
Setting Up a New Inhaler
Before you can use Stiolto Respimat for the first time, you need to insert the medication cartridge into the inhaler body. Keep the cap closed, then press the safety catch on the side while pulling off the clear base with your other hand. Be careful not to touch the small piercing element inside.
Take the cartridge and insert the narrow end into the inhaler. Place the inhaler upright on a hard, flat surface and push down firmly until you hear a click. Then snap the clear base back into place until it clicks. Once assembled, do not remove the clear base or cartridge again.
At this point, write the discard date on the inhaler’s label. That date is three months from the day you insert the cartridge, regardless of how much medication remains.
Priming Before First Use
A new inhaler needs to be primed so the spray mechanism is ready to deliver a full dose. To prime it, point the inhaler toward the ground and away from your face. Turn the clear base in the direction of the arrows until it clicks (this is a half turn), then open the cap fully and press the dose-release button. Repeat this turn-open-press sequence until you see a visible mist. It typically takes a few actuations. You only need to prime the device once when it’s new, though if you haven’t used it for more than seven days, you should spray one puff toward the ground before your next dose.
The T-O-P Inhalation Technique
Stiolto Respimat uses a three-step process called T-O-P: Turn, Open, Press. You’ll repeat this sequence twice for each dose, since one full dose is two puffs.
Turn: With the cap still closed, turn the clear base in the direction of the arrows on the label until it clicks. This is about a half turn, and it loads one puff of medication.
Open: Flip the cap open until it snaps fully upright.
Press: This step requires the most attention. Breathe out slowly and completely before putting the inhaler to your mouth. Close your lips around the mouthpiece, but don’t cover the small air vents on the sides. Point the inhaler toward the back of your throat. As you begin taking a slow, deep breath in through your mouth, press the dose-release button and keep breathing in steadily. The mist from a Respimat is much slower than a traditional inhaler, so there’s no need to rush your breath. After inhaling fully, hold your breath for 10 seconds or as long as you comfortably can.
Then close the cap and repeat all three steps for your second puff. Close the cap when you’re done.
Getting the Breathing Right
The most common mistake with Respimat inhalers is breathing in too fast. Unlike a standard metered-dose inhaler that fires a quick burst, the Respimat produces a slow, soft mist that lasts longer. Your inhalation should match that pace. Think of it as a long, steady sip of air rather than a sharp gasp. Breathing too quickly causes the medication to hit the back of your throat instead of reaching your lungs, which both reduces effectiveness and increases the chance of side effects like dry mouth.
Coordinating the button press with your breath can feel awkward at first. Start breathing in before you press the button, then press while continuing to inhale. This gives you a better chance of catching the full mist deep in your airways.
Dosing Schedule
The standard dose is two puffs once per day, at the same time each day. Each puff delivers 2.5 micrograms of tiotropium and 2.5 micrograms of olodaterol, so two puffs together give you the full daily dose of 5 micrograms of each medication. Do not take more than two puffs in 24 hours.
One cartridge contains 60 metered puffs, which equals 30 days of doses at two puffs per day. If you miss a dose, take it as soon as you remember, but skip it if your next scheduled dose is coming up soon. Never double up.
Tracking Remaining Doses
The inhaler has a built-in dose indicator on the side that changes color as medication runs low. When the indicator enters the red zone, you have roughly seven days of medication left. This is your signal to get a refill so you don’t run out. Once the indicator reaches the end of the red scale, the inhaler is empty and locks automatically so it can no longer be actuated.
Cleaning and Maintenance
At least once a week, clean the mouthpiece and the metal part inside it with a damp cloth or tissue. Don’t run it under water or submerge any part of the device. Medication residue can build up around the mouthpiece opening over time, and regular wiping prevents blockages that could reduce the amount of mist you receive.
Store the inhaler with the cap closed. Avoid leaving it in direct sunlight or in a hot car. Remember the three-month discard date you wrote on the label when you first assembled it. Even if the dose indicator shows medication remaining, replace the inhaler once that date arrives, because the formulation may not deliver reliably past that window.
Common Issues and Fixes
If the base won’t turn, make sure the cap is fully closed first. The mechanism is designed so that turning only works when the cap is down.
If you don’t see any mist when you press the button, the cartridge may not be seated properly, or the device may need re-priming. If it’s been more than a week since your last use, do one test spray pointed away from your face before taking your dose.
If the mist feels weaker than usual, check that the air vents on the mouthpiece aren’t blocked by your fingers or lips. Also clean the mouthpiece to remove any dried residue that might be narrowing the spray opening. A clean, unobstructed mouthpiece makes a noticeable difference in how well the device performs.