Patient/caregiver was educated on how to use Spiriva respimat 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 an inhalation spray, using a respimat inhaler.
  5. Always, check the expiration date on the respimat inhaler before using it. Shake the inhaler well for 5 seconds before every use.
  6. Hold the respimat inhaler upright and rotate the transparent base in the direction indicated, until you hear a click.
  7. Open the cap to expose the mouthpiece of the respimat inhaler. Leave the cap on the inhaler open, exposing the mouthpiece.
  8. Sit up straight or stand up. Holding the respimat inhaler away, perform a normal quiet breathing in and then, breathe out normally.
  9. Bring the respimat inhaler 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. Make sure the mouthpiece is clean before having it in the mouth, by wiping the mouthpiece with a clean towel before use.
  10. Make sure the tongue is not obstructing the mouthpiece, by having the mouthpiece over the tongue and not under.
  11. Close the mouth tightly around the mouthpiece.
  12. Breathe in slow and deep for a complete breath, for a count of 5 seconds. At the same time, activate the drug release button on the Spiriva inhaler, by pressing the button with the index finger. Performing both these acts at the same time is a task that will help delivery of the medication to the site of action in the airways and lungs. You can use the spacer, if you have difficulty coordinating these activities.
  13. Withdraw the mouthpiece 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.
  14. Breathe out slowly through the nose or mouth.
  15. One activation of the respimat inhaler counts for one puff. If you are ordered to have two puffs as your dose, wait for a minute before taking the second puff.
  16. For the second puff, start with shaking the respimat inhaler for 5 seconds and repeating all the steps of the procedure throughout.
  17. Replace the cap on the mouthpiece of respimat inhaler, once you completed inhalation of your prescribed dose.
  18. 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.
  19. Each respimat inhaler usually has 60 puffs of medication in it and will lock once all the doses are used up. An indicator shows on the side of the inhaler, when 14 more puffs of medication are left in the inhaler. Keeping a watch on this number allows you sufficient time to refill the medication.
  20. 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.