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Many medications are available as inhaled treatments. Inhaled methods deliver medication directly to the airway, which is helpful for lung diseases. The patient and healthcare provider can choose from a variety of delivery systems for inhaling medication. A Twisthaler® consists of a plastic device containing dry powdered medication. 

A Twisthaler® is breath activated. This means when you inhale, the Twisthaler® automatically releases the medication. When inhaled correctly, the medication has a better chance to reach the small airways. This increases the medication's effectiveness. The portable size, efficiency and convenience make the Twisthaler® a desirable method for inhalation treatment.

Before Using a New Twisthaler®

1.  Remove the Twisthaler® from the foil pouch.
2.  Write the current date on the cap label.  Throw away the Twisthaler 45 days after this day or when the dose counter reads 00, whichever comes first.


Preparing the Twisthaler® for Use

Holding a Twisthaler.
  1. Hold the Twisthaler® straight up with the pink portion on the bottom.  This is important to make sure you get the right amount of medicine.
  2. Remove the cap from the Twisthaler® by twisting off the cap. 
  3. As you lift off the cap the dose counter on the pink portion will count down by one. This action gets the medicine ready for you to inhale. 


Taking an Inhaled Treatment

Inhaling with a Twisthaler
  1. Hold the Twisthaler® away from your mouth and gently breathe out.
  2. Seal your lips around the mouthpiece.
  3. Inhale rapidly and deeply.  Continue to take a full, deep breath.
  4. Take the Twisthaler® out of your mouth. Hold your breath for 10 seconds.
  5. Resume normal breathing.  Do not breathe out into the Twisthaler.
  6. Close the Twisthaler® by twisting on the cap.  The indented arrow on the case should line up with the dose counter when the Twisthaler® is closed. Keep the cap on the Twisthaler® when not in use. This will keep the Twisthaler® clean and dry.
  7. Repeat steps 1-6 when more than one puff is prescribed.
  8. Rinse your mouth and spit out the water after inhaling the medication.


Identifying When the Twisthaler® Is Empty

Empty Twisthaler.
  1. The Twisthaler® has a dose counter on the pink base.
  2. The dose counter will show the doses of medicine left. When the dose counter shows 01, there is one dose left.
  3. When the Twisthaler® is empty the dose counter will show 00 and the pink base will not turn. Start using a new Twisthaler®.
  4. Note: There is an indented white arrow on the white portion above the pink base. This should always line up with the dose counter.  


This information has been reviewed and approved by Ann Mullen, RN, CNS, MSN, AE-C (December 2014)