This device is called a Twisthaler. It is a breath-activated device, which means the medication is released when you inhale.

To open the Twisthaler, hold the Twisthaler straight up with the pink or gray portion on the bottom. This is important to make sure the right dose of medication is loaded in the device.

Turn the Twisthaler cap to the right to remove it. As you turn the cap, this will load the next dose of medicine. Once you open the Twisthaler, make sure the indented arrow on the white portion of the Twisthaler lines up with the counter window.

Do not shake it or cough or breathe into it or you will lose some of the medication.

To take your medication, turn away from the mouthpiece and breathe out. Then carefully bring the Twisthaler to your mouth and seal your lips tightly around the mouthpiece. Breathe in rapidly and deeply and hold your breath for as long as you can up to 10 seconds.

After you take the dose, wipe the mouthpiece dry.

Replace the cap by twisting the cap to the right. You will hear a click when the cap is fully closed. The cap pointer will also line up with the counter window.

Repeat these steps for each dose you have been told to take.

Always rinse mouth with water and spit it out after using the Twisthaler.

The Twisthaler has a dose counter on the pink or grey base. It will let you know how many doses are left. As you turn the Twisthaler cap to take the cap off, the dose counter will count down by one. The Twisthaler will count down to 0 when the Twisthaler is empty.

To clean the Twisthaler, do not put it in water. Simply wipe the mouthpiece with a clean cloth when it appears dirty or at least every week. And then, be sure to keep the cap on the Twisthaler after each use to help it stay clean.

National Jewish Health has been ranked by US News and World Report as the number one respiratory hospital in the nation for 11 years in a row. Find out more at