Aerosol Guide - AARC.org

Technique Box 4. Steps for Correct Use of Each Model of DPIs (continued)
Twisthaler ® : (continued)
13. Be sure that the arrow is in line with the dose-counter window.
14. Store device in cool, dry place.
Flexhaler ® : The patient should be instructed to:
1. Twist the cover and lift it off.
2. Hold the Flexhaler ® in the upright position (mouthpiece up) while loading a dose.
3. Do not hold the mouthpiece when the inhaler is loaded.
4. Twist the brown grip fully in one direction as far as it goes. It does not matter which way
you turn it first.
5. Twist it full back in the other direction as far as it goes.
6. Make sure to hear a click during each of the twisting movements.
7. Be sure not to exhale into the device.
8. Place the mouthpiece into your mouth, seal the mouthpiece with your lips, and inhale
deeply and forcefully through the inhaler.
9. Remove the inhaler from your mouth and exhale.
10. Make sure that you do not blow into the mouthpiece.
11. If more than one dose is required, repeat the steps above.
12. Put the cover back on the inhaler and twist it shut.
13. Rinse your mouth with water after each dose to reduce the risk of developing thrush. Do
not swallow the rinsing water.
Tudorza Pressair: The patient should be instructed to:
1. Wash and dry your hands thoroughly.
2. Remove the protective cap by gently squeezing the marked arrows on each side of the cap
and pulling outward.
3. Hold the inhaler with the mouthpiece facing toward you and the green button on top. DO
NOT place in your mouth yet.
4. Press the green button all the way down and release it. DO NOT hold the button down.
5. Check the control window on the device (above the mouthpiece) to ensure the color has
changed from red to green, indicating the dose and device are ready for use.
6. Exhale away from the device before placing the mouthpiece into your mouth.
7. Place the mouthpiece into your mouth and breathe in quickly and deeply.
8. You will hear a CLICK when the dose is delivered, but continue with your deep breath until
your lungs are filled.
9. Remove the device from your mouth and breathe out.
10. Check the control window on the device (above the mouthpiece) to ensure the color has
changed from green to red. IF NOT, repeat Step 7.
11. Replace the protective cap on the mouthpiece.
General Steps To Avoid Reduced or No Dosing for DPIs: When using DPIs, the following steps
should be taken in order to avoid reduced or no dosing during aerosol treatment. The patient should:
1. Read and follow the instructions for proper assembly.
2. Make sure to keep the DPI clean and dry.
3. Keep the DPI in proper orientation during the treatment.
4. Be sure to puncture the capsule or blister pack.
5. Do not exhale into the DPI.
6. Make sure to generate adequate inspiratory flow.
7. Track the doses remaining in the DPI.
Troubleshooting: Problem with DPIs: Malfunctioning DPIs
Causes
Incorrect DPI assembly
Failure to discharge medicine
Empty DPI
Solutions
Check the assembly and reassemble, when needed.
Replace the unit.
Check the dose counter to ensure that it is not empty.
Otherwise, replace the DPI.
42 American Association for Respiratory Care A Guide to Aerosol Delivery Devices for Respiratory Therapists, 3rd Edition © 2013