Patient/caregiver was educated on how to use Spiriva HandiHaler as follows:

  1. Take the inhalation dose at the same time, every day, for the duration prescribed, to avoid forgetting the medication dose.
  2. Maintain strict compliance with inhalation of the medication as ordered, with regards to dosage and frequency, to derive the benefit of the medication. Compliance with the use of Spiriva inhalations as ordered, at regularly spaced intervals, is very important to prevent any exacerbation of asthma and COPD attacks.
  3. Do not change the dose on this medication without consulting your doctor. Do not overdose on the use of Spiriva inhalations, as it can significantly increase the chances of side effects and toxicity.
  4. Spiriva is administered as a dry-powder via oral inhalation, using a HandiHaler. This dry-powder is dispensed in a capsule.
  5. Open the cap and lift the mouthpiece, to expose the center chamber of the HandiHaler.
  6. Peel back the foil on the blister pack and remove one single capsule. Place the capsule in the center chamber of the HandiHaler.
  7. Spiriva capsules are to be used only for inhalation and not to be swallowed orally. Use only one capsule at a time in the handihaler device.
  8. Close the mouthpiece over the center chamber, until you hear a click. Leave the cap on the HandiHaler open, exposing the mouthpiece.
  9. Hold the HandiHaler upright, with the mouthpiece upwards.
  10. Press the green button in once fully and release, which helps to puncture the capsule in the center chamber and releases the dry-powder, ready for inhalation.
  11. From this point, do not breathe into the mouthpiece, as this can result in blowing away the medication powder from breathing into the lungs and medication wastage.
  12. Holding the handihaler away, perform a normal quiet breathing in and then, breathe out normally.
  13. Sit up straight or stand up. Bring the handihaler closer to your mouth and place the mouthpiece in between the teeth, with the chin up a little. This position of the chin will help better deposition of the medication into the airways.
  14. Make sure the mouthpiece is clean before having it in the mouth. Once every week, clean the handihaler with soap and water and dry it thoroughly with a clean towel. Let it air dry for an additional 10 minutes, before you can start using it again.
  15. Make sure the tongue is not obstructing the mouthpiece, by having the mouthpiece over the tongue and not under.
  16. Close the mouth tightly around the mouthpiece.
  17. Breathe in slow and deep for a complete breath, for a count of 5 seconds, which will help delivery of the powdered medication into the lungs.
  18. Withdraw the mouthpiece and handihaler from your mouth and hold your breath for a count of 5 seconds, giving time for the medication to be deposited into the airways, for it to act.
  19. Breathe out slowly through the nose or mouth and do one more inhalation having the mouthpiece in, to make sure that you are breathing in all of the powdered medication and no medication is getting wasted.
  20. Gargle and rinse the mouth with water after every dose of Spiriva inhalation. Spit out this water after rinsing and do not swallow. This helps prevent any unpleasant taste, dryness of the mouth, and any discomfort of throat irritation.
  21. Replace the cap on the mouthpiece of handihaler, once you completed intake of your prescribed dose.
  22. If you miss a dose, try taking it at the earliest notice of noncompliance. If it is time for the next dose, skip the missed dose and take the dose scheduled. Do not take an extra dose to try making up for the missed dose, to avoid overdose and toxicity with the medication. Notify your doctor and other health care personnel regarding your dose noncompliance.