Spiriva/Spiriva Respimat Caution For Usage

Instructions for Use/Handling: Spiriva: The HandiHaler device is especially designed for inhalation from Tiotropium bromide (Spiriva) capsules. It must not be used to take any other medication.
Handling Instructions: Remember to carefully follow doctor's instructions for using Tiotropium bromide (Spiriva). After first use, the patient can use the HandiHaler for up to one year to take the medication.
1. To release the dust cap press the piercing button completely in and let go.
2. Open the dust cap completely by pulling it upwards. Then open the mouthpiece by pulling it upwards.
3. Remove a Tiotropium bromide (Spiriva) capsule from the blister (only immediately before use, see blister handling as follows) and place it in the centre chamber. It does not matter which way the capsule is placed in the chamber.
4. Close the mouthpiece firmly until a click is heard, leaving the dust cap open.
5. Hold the HandiHaler device with the mouthpiece upwards and press the piercing button completely at once, and release. This makes holes in the capsule and allows the medication to be released when the patient breathes-in.
6. Breathe-out completely.
Important: Avoid breathing into the mouthpiece at any time.
7. Raise the HandiHaler device to the mouth and close lips tightly around the mouthpiece. Keep head in an upright position and breathe-in slowly and deeply but at a rate sufficient to hear the capsule vibrate. Breathe until lungs are full; then hold breath as long as comfortable and at the same time take the HandiHaler device out of the mouth. Resume normal breathing. Repeat steps 6 and 7 once, in order to empty the capsule completely.
8. Open the mouthpiece again. Tip out the used capsule and dispose. Close the mouthpiece and dust cap for storage of the HandiHaler device.
Cleaning the HandiHaler: Clean the HandiHaler device once a month.
Open the dust cap and mouthpiece. Then open the base by lifting the piercing button. Rinse the complete inhaler with warm water to remove any powder. Dry the HandiHaler device thoroughly by tipping excess water out onto a paper towel and air-dry afterwards, leaving the dust cap, mouthpiece and base open. It takes 24 hours to air dry, so clean it immediately after using it and it will be ready for the next dose. The outside of the mouthpiece may be cleaned with a moist but not wet tissue if needed.
Blister handling: A. Separate the Tiotropium bromide (Spiriva) blister strips by tearing along the perforation.
B. Peel back foil (only immediately before use) using the tab until one capsule is fully visible. In case a second capsule is exposed to air inadvertently this capsule has to be discarded.
C. Remove capsule.
The capsules should not be exposed to extreme temperatures.
Tiotropium bromide (Spiriva) capsules contain only a small amount of powder so that the capsule is only partially filled.
After first opening of the blister, use within 9 days.
Spiriva Respimat: Introduction: Children should use Tiotropium bromide (Spiriva Respimat) with an adult's assistance.
Use this inhaler only ONCE A DAY. Each time using it take TWO PUFFS.
If not been used for more than 7 days release one puff towards the ground.
If not been used for more than 21 days repeat steps 4 to 6 until a cloud is visible. Then repeat steps 4 to 6 three more times.
How to care for Tiotropium bromide (Spiriva Respimat) reusable inhaler: Clean the mouthpiece including the metal part inside the mouthpiece with a damp cloth or tissue only, at least once a week. Any minor discoloration in the mouthpiece does not affect the Tiotropium bromide (Spiriva Respimat) reusable inhaler performance.
If necessary, wipe the outside of the Tiotropium bromide (Spiriva Respimat) reusable inhaler with a damp cloth.
When to replace the inhaler: When the patient has used an inhaler with 6 cartridges, get a new Tiotropium bromide (Spiriva Respimat) reusable pack containing an inhaler. Do not use the Respimat reusable inhaler for more than one year, after having inserted the first cartridge.
Prepare for use: 1. Remove clear base: Keep the cap closed.
Press the safety catch while pulling off the clear base with the other hand.
2. Insert cartridge: Insert the cartridge into the inhaler.
Place the inhaler on a firm surface and push down firmly until it clicks into place.
3. Track cartridge and put clear base back: Mark the check-box on inhaler's label to track the number of cartridges.
Put the clear base back into place until it clicks.
4. Turn: Keep the cap closed.
Turn the clear base in the direction of the arrows on the label until it clicks (half a turn).
5. Open: Open the cap until it snaps fully open.
6. Press: Point the inhaler toward the ground.
Press the dose-release button.
Close the cap.
Repeat steps 4-6 until a cloud is visible.
After a cloud is visible, repeat steps 4-6 three more times.
The inhaler is now ready to use and will deliver 60 puffs (30 doses).
Daily use: Turn: Keep the cap closed.
TURN the clear base in the direction of the arrows on the label until it clicks (half a turn).
Open: OPEN the cap until it snaps fully open.
Press: Breathe out slowly and fully.
Close the lips around the mouthpiece without covering the air vents. Point the inhaler to the back of the throat.
While taking a slow, deep breath through the mouth, PRESS the dose-release button and continue to breathe in slowly for as long as comfortable.
Repeat Turn, Open, Press for a total of 2 puffs.
Close the cap until the inhaler is used again.
When to replace the Tiotropium bromide (Spiriva Respimat) cartridge: The dose indicator shows how many puffs remain in the cartridge.
Less than 10 puffs remaining. Obtain a new cartridge.
When the cartridge is used up. Turn the clear base to loosen it. The inhaler is now in a locked position. Pull off the cartridge from the inhaler. Insert a new cartridge (continue with step 2). The new cartridge will stick out more than the very first cartridge (continue with step 3). Remember to put the clear base back to unlock the inhaler.