Stiolto Respimat is a prescription combination inhaler used for long-term maintenance treatment of chronic obstructive pulmonary disease (COPD). It contains two bronchodilators that work through different mechanisms to open the airways, and it was approved by the FDA in May 2015. The medication is taken once daily and is not intended for treating asthma or for use as a rescue inhaler during sudden breathing emergencies.
How the Two Active Ingredients Work
Stiolto Respimat combines tiotropium (an anticholinergic) and olodaterol (a long-acting beta2-agonist, or LABA). Each puff delivers 2.5 mcg of tiotropium and 2.5 mcg of olodaterol, and the standard dose is two puffs once a day, taken at the same time each day. Those two puffs together equal one full dose.
The two drugs open the airways through completely different pathways, which is why combining them works better than either one alone. Tiotropium blocks a chemical messenger called acetylcholine from tightening the muscles around the airways. Olodaterol does the opposite job from the other direction: it activates receptors on those same airway muscles that signal them to relax. The result is a two-pronged approach to keeping the bronchial tubes open throughout the day.
How Quickly It Works and How Long It Lasts
Stiolto Respimat starts working fast. In clinical testing, lung function improved measurably within five minutes of the first dose, with an average increase in air volume (FEV1) of about 137 mL. That rapid onset comes primarily from the olodaterol component, while tiotropium contributes longer-lasting airway relaxation.
The bronchodilating effect covers a full 24-hour period, which is why once-daily dosing is sufficient. In studies that tracked lung function continuously for 12 hours and beyond, the combination maintained significantly better airflow compared to either tiotropium or olodaterol used on its own.
How Well It Improves Breathing
The clinical evidence for Stiolto Respimat is built on several large trials. Compared to placebo, the combination improved average lung function over 24 hours by 280 mL and improved the lowest point of lung function (trough FEV1) by 160 mL. Both numbers exceed the 100 to 140 mL threshold that researchers consider clinically meaningful, meaning the improvement is large enough for patients to actually notice a difference in daily breathing.
When compared to tiotropium alone, Stiolto Respimat produced an additional 105 to 111 mL improvement in peak lung function after each dose. These advantages held up consistently through 24 weeks of treatment in the TONADO trials and persisted at 52 weeks. Compared to olodaterol alone, the combination also showed consistent improvements, though the added benefit was smaller.
One particularly notable finding: Stiolto Respimat outperformed a commonly used inhaled steroid/LABA combination (salmeterol/fluticasone) by roughly 125 mL in lung function over 12 hours and about 85 mL over the full 24-hour dosing interval. This matters because it suggests that for many COPD patients, two bronchodilators together can do more for airflow than a bronchodilator paired with a steroid.
Where It Fits in COPD Treatment
Current COPD management guidelines from GOLD (the Global Initiative for Chronic Obstructive Lung Disease) position LAMA/LABA combinations like Stiolto Respimat as a core treatment option. For patients already on a steroid/LABA combination who don’t have frequent flare-ups or who have low blood eosinophil counts (below 100 cells per cubic millimeter), guidelines recommend switching to a LAMA/LABA combination rather than adding a third medication. Patients with more frequent exacerbations and higher eosinophil counts are typically directed toward triple therapy instead.
In practical terms, Stiolto Respimat fits best for people whose COPD is primarily driven by airway narrowing rather than inflammation, and who need sustained bronchodilation throughout the day.
The Respimat Inhaler Device
Stiolto Respimat uses a soft-mist inhaler rather than a traditional pressurized canister or dry powder device. The Respimat produces a slow-moving mist that lasts longer than the burst from a standard metered-dose inhaler, making it easier to inhale the medication deeply into the lungs. This is especially helpful for people who have difficulty coordinating a deep breath with pressing a canister.
Setting up the device for the first time takes a few steps. You insert the narrow end of the drug cartridge into the inhaler and press it down on a firm surface until about an eighth of an inch remains visible. Once inserted, the cartridge should not be removed. Before your first use, the inhaler needs to be primed: with the cap closed, you twist the clear base in the direction of the arrows until it clicks, open the cap, point the inhaler toward the ground, and press the dose-release button. You repeat this process until you see a visible cloud of mist, then do it three more times after that. This ensures the device is delivering a consistent dose when you start using it.
If you haven’t used the inhaler for more than three days, you should spray one puff toward the ground before using it again. If it’s been more than 21 days, you’ll need to re-prime with the full sequence.
Common Side Effects
The most frequently reported side effects with Stiolto Respimat reflect what you’d expect from its two drug classes. The anticholinergic component (tiotropium) can cause dry mouth, constipation, and urinary difficulty. People with narrow-angle glaucoma or an enlarged prostate need to use this medication cautiously, since anticholinergics can worsen both conditions.
The LABA component (olodaterol) can cause a faster heartbeat, muscle cramps, and headache. As with all LABAs, there’s a small risk of paradoxical bronchospasm, where the airways tighten instead of relaxing right after using the inhaler. If that happens, you should stop using it and contact your doctor. People with heart rhythm disorders, high blood pressure, or seizure disorders should discuss these risks before starting the medication.
Stiolto Respimat is not approved for asthma. LABAs used without an inhaled corticosteroid have been associated with serious asthma-related events, and this combination does not contain a steroid component.