The Medical Letter publications are protected by US and international copyright laws. Forwarding, copying or any other distribution of this material is strictly prohibited. For further information call: 800-211-2769 Correct Use of Inhalers Last updated: February 14, 2018 The Medical Letter on Drugs and Therapeutics Correct Use of Inhalers Ellipta Inhalers Remove inhaler from foil tray Open the cover of the inhaler; when a click is heard, the inhaler is ready to use The dose indicator should count down by 1 Do not block the air vent on top of the inhaler Inhale with a long, steady, deep breath through the mouth Hold breath for 3-4 seconds Exhale slowly Respimat Inhalers Remove the clear base from the inhaler device Keep the cap closed Avoid touching the piercing element Insert the narrow end of the cartridge into the inhaler Push down on the inhaler on a firm surface until the cartridge clicks into place Push the clear base back onto the inhaler until it clicks Turn the clear base ½ turn in the direction of the arrows until it clicks Open the inhaler cap Hold inhaler horizontally Do not block air vents on side of inhaler with mouth or fingers Press the dose-release button while inhaling slowly and deeply though the mouth Hold breath for 10 seconds or as long as comfortable Close the cap Prime the inhaler before first use and if not used for >21 days Turn the clear base ½ turn in the direction of the arrows Open the cap Press the dose-release button with inhaler pointed toward the ground Close the cap Repeat until a mist is seen Once a mist is seen, repeat 3 times If not used for >3 days, actuate the inhaler once before administration of a dose It may not be possible to taste or feel the medication No assembly required Doses may be wasted if inhaler is opened/closed accidentally Discard 6 weeks after the tray is opened Inhalation spray inhaler Drug delivery to the lungs is not dependent on strength of breath intake Assembly may be difficult for some patients Priming required Indicator shows approximately how many doses are left The inhaler will lock when it is empty Discard 3 months after insertion of cartridge Clean mouthpiece with a damp cloth or tissue at least once/week e1 Anoro Ellipta (umeclidinium/vilanterol): www.accessdata.fda.gov/drugsatfda_docs/label/2016/203975s003lbl. pdf#page=27-30 Arnuity Ellipta (fluticasone furoate): www.accessdata.fda.gov/drugsatfda_docs/label/2014/205625s000lbl.pdf Breo Ellipta (fluticasone furoate/vilanterol): www.fda.gov/downloads/drugs/drugsafety/ucm352347.pdf Incruse Ellipta (umeclidinium): www.accessdata.fda.gov/drugsatfda_docs/label/2016/205382s002lbl.pdf Trelegy Ellipta (fluticasone furoate/umeclidinium/vilanterol): www.accessdata.fda.gov/drugsatfda_docs/label/2017/209482s000lbl. pdf#page=33 Combivent Respimat (ipratropium/albuterol): www.accessdata.fda.gov/drugsatfda_docs/label/2016/021747s013lbl.pdf Spiriva Respimat (tiotropium): www.accessdata.fda.gov/drugsatfda_docs/label/2017/021936s007lbl.pdf Striverdi Respimat (olodaterol): www.accessdata.fda.gov/drugsatfda_docs/label/2016/203108s003lbl.pdf Stiolto Respimat (tiotropium/olodaterol): www.accessdata.fda.gov/drugsatfda_docs/label/2016/206756s006lbl. pdf#page=14
Neohaler Inhalers Remove inhaler cap Open the inhaler by firmly holding the base and tilting the mouthpiece Remove one capsule from the blister package with dry hands Peel off protective backing to expose foil Push capsule through the foil Only remove capsule immediately before use Place the capsule into the chamber in the inhaler base While holding the inhaler upright, pierce the capsule by pressing the two capsule piercing buttons at the same time until a click is heard Hold inhaler with the buttons on the left and right Inhale with a rapid, steady, deep breath through the mouth Hold breath for as long as comfortable The capsule should make a whirring noise during inhalation If there is no whirring noise, open the inhaler and loosen the capsule by tapping the inhaler base After inhalation, open the inhaler and check for powder left inside the capsule If there is still powder in the capsule, another inhalation may be needed 1-2 inhalations are usually required to empty the capsule Discard the empty capsule after use Pressair Inhaler Remove inhaler from pouch Remove the inhaler cap by squeezing the arrows on each side of the cap and pulling outward Hold the inhaler with the green button facing up and the mouthpiece facing toward the mouth Press the green button Release the green button Check control window for a green bar; this indicates the dose is ready to inhale If the control window is red, the dose is not ready Inhale rapidly and deeply through the mouth A click should be heard, continue to inhale even after the click is heard Hold breath for as long as comfortable Check the control window to see if it has turned red If the window is red, the full dose has been delivered If the window is still green, another inhalation is needed Replace the inhaler cap Each package contains an inhaler consisting of a cap and a base and a card of blister-packaged capsules Transparent capsules may be helpful in determining if the full dose was inhaled Capsules should not be swallowed Removal of the capsule from the foil pack and insertion into the inhaler may be difficult for some patients (Arcapta) (Seebri and Utibron) Easy to use Discard 45 days after opening pouch Indicator shows approximately how many doses are left Arcapta Neohaler (indacaterol): www.accessdata.fda.gov/drugsatfda_docs/label/2012/022383s002mg.pdf Seebri Neohaler (glycopyrrolate): www.accessdata.fda.gov/drugsatfda_docs/label/2017/207923s002lbl.pdf Utibron Neohaler (glycopyrrolate/indacaterol): www.accessdata.fda.gov/drugsatfda_docs/label/2017/207930s002lbl.pdf Tudorza Pressair (aclidinium): www.accessdata.fda.gov/drugsatfda_docs/label/2016/202450s006lbl.pdf e2
Handihaler Inhaler Open the inhaler cap by pressing the green piercing button Open the mouthpiece by pulling up and away from the inhaler base Remove one capsule from the blister package by peeling back the printed foil Place the capsule into the center chamber in the base of the inhaler Close the mouthpiece A click indicates the mouthpiece is closed Hold the inhaler with the mouthpiece facing up Press the green piercing button once until it is flat against the base and then release Do not block the air intake vents Inhale deeply Hold breath for a few seconds The capsule should rattle or vibrate during inhalation If there is no vibration or rattling, tap the inhaler gently on a firm surface with the mouthpiece facing up and check that the mouthpiece is closed completely Repeat inhalation to administer the full dose Discard the empty capsule after use Tap inhaler to remove any powder dust or capsule pieces Close inhaler cap Diskus Inhalers Remove the inhaler from the foil pouch Open the inhaler by sliding the outer case until the mouthpiece is visible and the outer case snaps into position Hold the inhaler in a flat, level position Prepare the dose by sliding the lever next to the mouthpiece away from you until it clicks Inhale quickly and deeply through the mouth Respiclick Inhalers Remove inhaler from foil pouch Open the cap until a click is heard A click indicates the dose is ready Do not block air vent above mouthpiece with lips or hands Inhale rapidly and deeply through the mouth Hold breath for about 10 seconds or as long as confortable Close the cap perform a rapid, Each package contains an inhaler device and a card of blister-packaged capsules Inserting the capsules into the device may be difficult for some patients Capsules should not be swallowed Clean device as needed with warm water; 24 hours is required to air dry the device perform a rapid, Discard 1 month after opening pouch perform a rapid, Doses may be wasted if inhaler is opened/closed accidentally Discard 13 months after removing inhaler from the foil pouch (AirDuo and ArmonAir) Spiriva Handihaler (tiotropium): www.accessdata.fda.gov/drugsatfda_docs/label/2015/021395s040lbl.pdf Advair Diskus (fluticasone propionate/salmeterol): www.accessdata.fda.gov/drugsatfda_docs/label/2011/021077s046medg.pdf Flovent Diskus (fluticasone propionate): www.accessdata.fda.gov/drugsatfda_docs/label/2016/020833s032lbl.pdf Serevent Diskus (salmeterol): www.accessdata.fda.gov/drugsatfda_docs/label/2011/020692s038medg.pdf ProAir Respiclick (albuterol): www.accessdata.fda.gov/drugsatfda_docs/label/2016/205636s006lbl.pdf AirDuo Respiclick (fluticasone propionate/salmeterol): www.accessdata.fda.gov/drugsatfda_docs/label/2017/208799s000lbl.pdf ArmonAir Respiclick (fluticasone propionate): www.accessdata.fda.gov/drugsatfda_docs/label/2017/208798s000lbl.pdf e3
Flexhaler Inhaler Twist to remove the white cover perform a rapid, Twist the brown grip in one direction as far as it will go, then twist it fully back again in the other direction A click should be heard during one of the twisting movements Inhale rapidly and deeply Exhale Replace the cover and twist to close Prime inhaler before first use Hold the inhaler upright by holding the brown grip at the bottom Remove white cover Twist the brown grip as far as it will go in one direction, then twist it fully back again in the other direction A click should be heard during one of the twisting movements Repeat the twisting step Twisthaler Inhaler Remove the inhaler from the foil pouch Twist to remove the cap The dose indicator should count down by 1 Do not cover the ventilation holes with the lips or hands Inhale rapidly and deeply Wipe the mouthpiece dry Replace the cap by twisting until it clicks Redihaler Inhaler Open the white cap Inhale deeply Hold breath for 5-10 seconds Exhale slowly Close the white cap The white cap must be closed, then reopened to prepare another dose It may not be possible feel or taste the medication Indicator shows about how many doses are left Priming required perform a rapid, Discard 45 days after opening foil pouch Once- or twice-daily dosing HFA MDI (breath-actuated) Does not require hand/breath coordination Rinse mouth after using an inhaler containing a corticosteroid The white cap must be closed to prepare a dose; only open the cap when ready to take a dose Pulmicort Flexhaler (budesonide): www.accessdata.fda.gov/drugsatfda_docs/label/2010/021949s006lbl.pdf Asmanex Twisthaler (mometasone): www.accessdata.fda.gov/drugsatfda_docs/label/2010/021067s013lbl.pdf QVAR Redihaler (beclomethasone): www.accessdata.fda.gov/drugsatfda_docs/label/2017/207921s000lbl.pdf e4
Hydrofluoroalkane Metered-Dose Inhalers (HFA MDIs) General Instructions for HFA MDIs: Prime inhaler before use if needed Shake inhaler if needed Press canister down and inhale deeply and slowly through the mouth at the same time Wait about 30-60 seconds before administering another inhalation HFA MDIs require hand/breath coordination Priming required: Advair HFA, Aerospan HFA, Alvesco, Atrovent HFA, Bevespi Aerosphere, Dulera, Flovent HFA, ProAir HFA, Proventil HFA, QVAR, Symbicort, Ventolin HFA, Xopenex HFA Shaking required: Advair HFA, Aerospan HFA, Bevespi Aerosphere, Dulera, Flovent HFA, ProAir HFA, Proventil HFA, Symbicort, Ventolin HFA, Xopenex HFA Dose indicator: Advair HFA, Alvesco, Atrovent HFA, Bevespi Aerosphere, Dulera, Flovent HFA, ProAir HFA, QVAR, Symbicort, Ventolin HFA, Xopenex HFA Advair HFA (fluticasone propionate/salmeterol): www.accessdata.fda.gov/drugsatfda_docs/label/2017/021254s026lbl.pdf#page=46 Aerospan HFA (flunisolide): www.accessdata.fda.gov/drugsatfda_docs/label/2013/021247s008lbl.pdf Alvesco (ciclesonide): www.accessdata.fda.gov/drugsatfda_docs/label/2012/021658s006lbl.pdf Asmanex HFA (mometasone): www.accessdata.fda.gov/drugsatfda_docs/label/2016/022518s019,205641s005lbl.pdf Atrovent HFA (ipratropium): www.accessdata.fda.gov/drugsatfda_docs/label/2012/021527s021lbl.pdf Bevespi Aerosphere (glycopyrrolate/formoterol): www.accessdata.fda.gov/drugsatfda_docs/label/2016/208294s000lbl.pdf Dulera (mometasone/formoterol): www.accessdata.fda.gov/downloads/drugs/drugsafety/ucm217561.pdf Flovent HFA (fluticasone propionate): www.accessdata.fda.gov/drugsatfda_docs/label/2016/021433s032lbl.pdf ProAir HFA (albuterol): www.accessdata.fda.gov/drugsatfda_docs/label/2012/021457s026lbl.pdf Proventil HFA (albuterol): www.accessdata.fda.gov/drugsatfda_docs/label/2012/020503s046lbl.pdf QVAR (beclomethasone): www.accessdata.fda.gov/drugsatfda_docs/label/2014/020911s025lbl.pdf Symbicort (budesonide/formoterol): www.accessdata.fda.gov/drugsatfda_docs/label/2017/021929s013lbl.pdf#page=45 Ventolin HFA (albuterol): www.accessdata.fda.gov/drugsatfda_docs/label/2014/020983s032lbl.pdf Xopenex HFA (levalbuterol): www.accessdata.fda.gov/drugsatfda_docs/label/2017/021730s039lbl.pdf#page=20 e5