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Common Respiratory Drugs
Inhaler Instructions

Inhaler Instructions

Turbuhaler

1. Unscrew the cover and lift it off. Do not shake.
2. For Symbicort, load medicine by holding the inhaler upright and turning the coloured grip on the bottom clockwise until you hear a click. Twist the coloured grip back counter-clockwise as far as it will go. (If you are opening a brand new container of Symbicort, you must do this action twice to “prime” it so that it is ready for use . Load as directed for the actual dose).
 For Pulmicort, Oxeze and Bricanyl, load medicine by holding the inhaler upright and turning the coloured grip counter-clockwise first then clockwise until it clicks.
3. Turn head away from the Turbuhaler and breathe out normally to the end of a normal breath. Do not blow out into the Turbuhaler.
4. Put the mouthpiece past your lips and between your teeth and close lips firmly around it. Tilt head back slightly.
5. Breathe in quickly and deeply through your mouth.
6. Remove the Turbuhaler from your mouth and hold your breath for 5-10 seconds if possible.
7. Breathe out slowly.
8. If a second dose is ordered, repeat steps 2 through 7.
9. Replace the cover and screw it shut.
10. Gargle with water and spit out if you are using a corticosteroid (Symbicort or Pulmicort). This is an important step to help to prevent potential side effects from the corticosteroid (sore throat, hoarse voice, oral thrush).

Cleaning Instructions

1. Clean mouthpiece once a week and as needed with a dry tissue. Never use a wet cloth.
2.  Store in a clean, dry place – preferably not the bathroom as it is too humid.
3.  Regularly check the counter for remaining doses. For Symbicort, the Turbuhaler is empty when the counter is at ”0” in the middle of the counter window. For Pulmicort, Oxeze and Bricanyl, the Turbuhaler has 20 doses left when the red mark first appears in the counter window.

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Metered-Dose Inhaler

1. Remove the cap from the mouthpiece.
2. Shake the inhaler well for at least 5 seconds.
3. Tilt your head back slightly.
4. Hold the inhaler upright with the mouthpiece about 3-5 cm (2 inches or two finger widths) away from your mouth and aim it toward the back of the throat.
5. Breathe out normally and slowly.
6. Open mouth wide.  Begin to inhale slowly through your mouth and press down on the canister once. Continue the slow, deep breath in until your lungs are full.
7. Close your mouth and hold your breath for 5-10 seconds if possible, then breathe out.
8. If a second dose is ordered, wait 60 seconds then repeat steps 2-7. The waiting time is for the canister to recharge itself so that you get the full dose of medicine on the second puff.
9. Replace cap.
10. Gargle with water and spit out if you are using a corticosteroid either alone (Flovent, QVAR or Alvesco – the orangey-brown inhalers) or in combination with a long-acting bronchodilator (Advair – the purple inhaler). This decreases the possibility of getting side effects from the corticosteroid (oral thrush, sore throat and hoarse voice).
11. Check package insert for instructions regarding number of priming puffs required when opening a new inhaler.

Cleaning Instructions

1. The mouthpiece should be cleaned once a week and as needed.
2. Remove the canister from the mouthpiece and clean the mouthpiece with warm water. Shake excess water out and dry it with a clean cloth. When the case is dry, reinsert canister and spray once into the air to ensure it is in working order.

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Metered-Dose Inhaler with a Spacer

1. Take the plastic caps off both the metered-dose inhaler and spacer mouthpieces.
2. Shake the inhaler well for 5 seconds.
3. Insert the metered-dose inhaler into the large rubber ring opening of the spacer device, keeping the inhaler in an upright position.
4. Breathe out normally and slowly away from the mouthpiece. Do not breath in yet.
5. Put the mouthpiece of the spacer into your mouth past your teeth. Close your lips on the mouthpiece. Do not cover the small slots on the spacer.
6. Press the inhaler so that the medication sprays into the spacer.
7. Breathe in slowly until your lungs are completely full (If you breathe in too quickly, the spacer will whistle). Hold breath for 5-10 seconds. If you can’t take or hold a deep breath, breathe in and out from the spacer for 4 breaths in a row, keeping your lips sealed around the mouthpiece. Do not breathe through your nose.
8. Remove spacer from mouth.
9. If a second puff is ordered, wait 60 seconds and repeat steps 2-8.
10. Gargle with water and spit after using a corticosteroid (Flovent, Advair, QVAR or Alvesco)to help prevent possible side effects (sore throat, hoarse voice, oral thrush).

Download Metered-Dose Inhaler with a Spacer Instructions

Washing the Spacer

Wash the spacer once a week.
1. Take apart the spacer as directed in the package instructions.
2. Place in a sink filled with warm water, with a drop of mild dish soap. Do not put in dishwasher.
3. Let soak for 5-15 minutes and gently shake the pieces through the soapy water to clean any residue.  (DO NOT USE A CLOTH OR BRUSH INSIDE THE MAIN CHAMBER.)
4. Pull the main chamber through the soapy water, shake out any excess water and place on a dish rack or towel to dry. (DO NOT RINSE THE INSIDE OF THE MAIN CHAMBER).  You want to leave a soapy film on the inside to get rid of the static charge so the medication does not stick to the inside.
5.  Rinse the remaining pieces (i.e. the mouthpiece, and any parts that are separate from the chamber) with clean water, shake off the excess water and allow to dry thoroughly on a tea towel or drying rack. Do not use paper towel – this may cause a static charge.
6. Put the spacer back together as directed.
 
Replace the spacer every 12-18 months.

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Diskus

1. Open the device by holding the outer case with one hand and placing the thumb of the other hand on the thumb grip attached to the cover.
2.  Using the thumb, push (rotate) the cover sideways (counter-clockwise) as far as it will go until a click is heard.  The device should now be open.
3.  With the mouthpiece facing you, slide the loading lever away as far as it will go and until it clicks.  Do not touch the lever until you are ready to use it.
4. Breathe out slowly, away from the Diskus. Do not breathe out into the Diskus and do not breath in yet.
5. Tilt head back slightly. Place the mouthpiece between your lips, keeping your teeth apart.
6. Now breathe in steadily and as deeply as you can until your lungs are completely full.
7. Remove Diskus from your mouth and hold your breath for 5 to 10 seconds.
8. Breathe out slowly.
9. lose the device by sliding the thumb grip back towards you as far as it will go.
10. The counter on the front of the device will count down to zero with each dose. Recycle the Diskus at your Pharmacy when the counter reads “0”.
11. Gargle with water and spit out if you are using a corticosteroid either alone (Flovent - the orange Diskus) or in combination with a long-acting bronchodilator (Advair - the purple Diskus).  This will help to reduce the possibility of oral thrush, sore throat and hoarse voice. You do not need to rinse your mouth after using Serevent Diskus as it is not a corticosteroid.

Cleaning Instructions

1. To clean the mouthpiece, wipe it with a dry tissue. Do not immerse in water.

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Handihaler

1. Push green lever in once all the way and release. This will release the outer cover.
2. Lift open outer cover and then lift open the white mouthpiece.
3. Right before use, remove one (only) SPIRIVA capsule from the blister pack and place it in the capsule chamber.
4. Close the mouthpiece firmly until you hear a click, leaving the lid open.
5. Hold the HandiHaler upright and press the green button once all the way in and release.
6. Breathe out gently, to the end of a normal breath with head turned away from the mouthpiece. Do not blow out into the mouthpiece and do not breath in yet.
7. Tilt chin up slightly. Place HandiHaler in your mouth and seal your lips around the mouthpiece.
8. Now breathe in slowly and deeply through your mouth until your lungs are full and hold your breath for 5-10 seconds. You will usually be able to hear the capsule vibrating as you breathe in.
9. Repeat steps 6-8. You must take two breaths from one capsule but you do not need to press the green button for the second breath.
10. Open the mouthpiece. Turn Handihaler upside down over the garbage can to get rid of the used capsule. Do not touch the capsule once it has been punctured. Wash your hands.
11. Close the mouthpiece and lid.

Cleaning Instructions

1. Clean the HandiHaler by hand once per month or as needed. Do not place in dishwasher.
2. Open the lid, lift up the mouthpiece and lift up the piercing button to open the base.
3. Rinse the HandiHaler with warm water to remove any powder.  Do not use soap.
4.  Shake out the excess water and leave the lid, mouthpiece and base open until unit is completely dry. The best time to clean the HandiHaler is directly after use to allow 24 hours to air dry before next use

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Diskhaler

1. Remove cap and hold the Diskhaler flat and level.
2. Lift the flip-up cover (the back of the lid) so that it is fully upright and the plastic needle punctures BOTH SIDES of the blister on the disk. Close the flip-up cover.
3. Breathe out to the side, away from the mouthpiece. Do not exhale into the Diskhaler.
4. Place mouthpiece between the teeth and close lips firmly around it without blocking the holes on the sides of the mouthpiece. Tilt head slightly back.
5. Breathe in quickly and deeply.
6. Hold the breath for as long as possible—a minimum of 10 seconds.
7. Remove Diskhaler from mouth and breathe out slowly. Check that all the medication has been breathed in, if not, repeat steps 3-6.
8. To take a second dose:
-slide the white cartridge out, and then back in, so that the next blister is in position.
-perform steps 2-7.
9. Replace cap after use.
10. Do not pierce the next blister until just before next inhalation.

Cleaning Instructions

1. Use the brush provided under the lid to clean the tray, the area behind the mouthpiece and the mouthpiece.
2. Brush away all remaining powder and ensure that the air holes in the mouthpiece are not blocked.

Aerolizer

1. Remove blue cover.
2. Hold the base firmly and turn the mouthpiece in the direction of the arrow.
3. A recess (shaped to match the capsule) will now be visible in the base. Place capsule into the recess.
4. Return mouthpiece to original position.
5. Keep inhaler upright and firmly squeeze the two blue buttons once to puncture the capsule. Release buttons.
6. Breathe out to the side, away from the Aerolizer.
7. Place mouthpiece between the teeth and close lips firmly around it. Tilt head slightly back.
8. Breathe in deeply and steadily.
9. Remove Aerolizer from mouth and hold the breath for as long as possible—at least 10 seconds.
10. Breathe out slowly.
11. To take a second dose, open the inhaler, remove the empty capsule and repeat steps 3-8.
12. Replace cover on Aerolizer.

Cleaning Instructions

1. Empty capsule fragments have to be removed from the compartment prior to insertion of a new capsule of medication.
2. The mouthpiece and capsule compartment should be wiped with a soft dry cloth or the small brush included with the medication. This is done in order to remove any powder residue.

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