Asthma add-on treatments are very important for people who experience asthma which is difficult to treat and also for people diagnosed with ‘severe asthma. Difficult to treat asthma means asthma which results in frequent and troubling symptoms despite effective use of regular preventer treatment and positive lifestyle choices (avoiding smoking and other triggers where possible) and management of other conditions which can have a negative impact on asthma. For people with ‘difficult to treat’ asthma, add-on treatments are often very helpful in controlling symptoms and reducing how often and how bad flare-ups are experienced. Add-on treatments are prescribed by a Respiratory Specialist.  

There is a new version of an existing add-on medication – Spiriva Respimat – in Australia, and Asthma Australia would like to update you on this so you’re informed and empowered to know your options and make the best choices for you and your family. 


Asthma is a long-term condition of the airways (the passage that transports air into our lungs). At the moment there is no cure, but for many people, it can be managed with the right treatment. Asthma is recognised by the following: 

  • Tightening of the airways 
  • Swelling and inflammation in the airways 
  • Mucus production inside the airways 

These lead to asthma symptoms which are commonly experienced as breathlessness, cough, chest tightness, and wheeze. Flare-ups happen when symptoms persist, don’t improve with reliever use, or become severe. 



The main goal of asthma treatment is to obtain control and prevent ‘asthma attacks’ or ‘flare-ups’. The most important treatment, therefore, is anti-inflammatory medicine which treats the inflammation which causes swelling and mucus production. This is effective for most people with asthma in keeping symptoms at bay. The most common and recommended anti-inflammatory medicines, known as preventers, are inhaled, and they work in the lungs, where the inflammation happens. 


The other part of medical treatment in asthma involves the use of a bronchodilator, which aims to relax the muscles in the airways. Commonly known as relievers or dual-purpose relievers, these medicines are also inhaled and provide quick relief of symptoms. Relievers are usually used alongside preventers to treat symptoms that breakthrough despite tailored preventer treatment. 

Dual purpose relievers (budesonide/formoterol): where a combination of these two ingredients in the single inhaler, when used as needed, relieve symptoms and reduces your risk of experiencing serious asthma flare-ups (attacks) addressing inflammation of the airways.   

Combination preventers

Some inhaled preventers come in combination form, and they are called combination preventer inhalers. They contain both the preventer and reliever types of medications and they work by both reducing the inflammation in the airways (anti-inflammatory) and relaxing the tight airway muscles (bronchodilator). Combination preventers contain two medications: an inhaled corticosteroid to reduce inflammation, and a long-acting medication to relax tight airway muscles.  

Add-on treatments

Add-on treatments in asthma are medicines that are added to a persons daily regime when asthma symptoms persist despite the correct use of tailored preventer therapy. There are a number of add-on treatments available in asthma and they work in different ways. Some work by reducing the cause of airway inflammation and others work by relaxing airway muscles  


Spiriva Respimat (tiotropium bromide) is an add-on inhaler available by prescription only for children six years and over and adultwith difficult to treat asthma. Spiriva Respimat can only be prescribed to people who have poor control of their symptoms despite correct and regular use of inhaled preventer medicines and who have experienced a serious flare-up which has required treatment by oral or injectable corticosteroids. Spiriva Respimat works by relaxing the muscles around the airways and works for over 24 hours. 


The new Spiriva Respimat device has been redesigned as follows 

  • The device can be used with up to six refill cartridges. This means that after finishing one cartridge, you can reuse the inhaler another five times 
  • This means that when you obtain your new medicine at the pharmacy you will be given only the medicine cartridge to insert into the device 
  • Your pharmacist can show you how to load your refill cartridge into your device  
  • The new device comes with a larger dose counter. This is different from the old device in that it indicates how many puffs remain in the device.  
  • The new device has a cartridge counter so you can keep track of how many cartridges you’ve gone through by ticking the label every time a new cartridge has been inserted.


If you have been using Spiriva Respimat in your asthma management plan, this change should not affect you significantly, but mainly means you don’t need to dispose of your device each time your cartridge is empty. 

If Spiriva Respimat is part of your asthma management plan, this might be a good time to arrange aasthma review with your doctor and update your written Asthma Action Plan to ensure you have clear and manageable instructions around what to do in case of worsening asthma. 


Your doctor or pharmacist will advise you on how to use your inhaler. Usually, you will be advised to take two consecutive inhalations per day, every dayIt is important to use your Spiriva Respimat device correctly in order to get the most benefit from the medicine. 

Please note that these steps can either be done by yourself or performed by your pharmacist.

For more information, click here.

Other important points: 

  • Always keep the Spiriva Respimat dry and clean by wiping with a damp cloth or tissue at least once a week, including the metal part inside the mouthpiece 
  • Try to keep your device in a cool, dry place 
  • Keep an eye on the dose counter and see your doctor or pharmacist for a replacement when it’s low. 


  • The manufacturer of Spiriva Respimat has updated the device but your prescription or routine should not change 
  • Spiriva Respimat is an add-on treatment that may be prescribed for people six years and older who can’t achieve good asthma control and continue to have serious flare-ups 
  • Ensure your written Asthma Action Plan is current and you can understand and follow it 
  • Children six years and older who are prescribed Spiriva Respimat must be under the care of a Paediatrician or Respiratory Specialist 
  • If symptoms are still not controlled whilst using Spiriva Respimat it is important to review your asthma urgently. 

Want to know more? For more information about Spiriva Respimat or to speak with an Asthma Educator about your asthma, call 1800 ASTHMA (1800 276 462).