Dry Powder Inhaler (DPI): Twisthaler®

Figure 1

What is a dry powder inhaler (DPI)?

Some asthma medications can be taken in the form of a dry powder using a small, hand-held device called a dry powder inhaler (DPI). DPIs deliver medication to the lungs as you inhale through the device. The DPI does not push the medication into your lungs. You will have to breathe in strong and steady to get the medicine.

What is the Twisthaler® DPI?

The Twisthaler® (Figure 1) contains the inhaled steroid (generic name) mometasone (brand name is Asmanex®), which comes in two strengths: 110 mcg (grey) and 220 mcg (pink). When you get a new Twisthaler, remove it from the foil pouch and write the date on the cap. The Twisthaler will need to be thrown out 45 days after this date or when the dose counter reads “0” (Figure 2 below shows the dose counter). The Twisthaler has a dose counter that automatically counts down the dose when the cap is removed. This action also loads the dose of medication. When the counter reads “00," there is no medicine left in the Twisthaler. Throw away the empty Twisthaler and begin using a new one.

How do I prepare the Twisthaler?

While holding the Twisthaler upright, twist the white cap counter clockwise. (Figure 2 )

Figure 2

As you lift off the cap, the dose counter on the base will count down by one.

How do I inhale my medication?

1. While holding the Twisthaler level and away from your mouth, gently blow out all the air from your lungs.
2. Hold the Twisthaler horizontally and place the mouthpiece between your teeth sealing your lips tightly around the mouthpiece (Figure 3). Do not cover the ventilation holes.
3. Breathe in strong and steady, but not too fast, and fill your lungs completely.
4. Hold your breath for 10 seconds.
5. Remove the Twisthaler from your mouth and exhale slowly. Wipe off the mouthpiece. Replace the cap and twist clockwise. Make sure it clicks to completely close it. (This must be done to properly load the next dose.)
6. If more than one dose is prescribed, repeat the previous steps for each dose.
7. Rinse your mouth and gargle (do not swallow), then spit, because this is a steroid medication.

Figure 3

How do I care for my Twisthaler DPI?

• Keep your Twisthaler in a dry place at room temperature.
• Never place the Twisthaler in water.
• Never shake or breathe into the Twisthaler.
• Never use a spacer device/holding chamber with the Twisthaler.
• Unlike other inhaled medications, you may not taste or feel the dry powder or there may be a slight sweet taste. This experience may be different from what you are used to. As long as you are following the directions, you will get your full dose of medication.