How To Use Your Twisthaler

Are You Using Your Twisthaler Correctly?

Doctor in discussion with patient in exam room
Discussing Asmanex Inhaler. Thomas Barwick/Getty Images

“How do I use my Asmanex Twisthaler?” is a common question amongst asthma patients, especially if they are not given instructions before leaving their doctor’s office or pharmacy. 

The Asmanex Twisthaler is a plastic device that contains your asthma medication in the form of powder. It's a breath activated inhalation delivery system for delivering Asmanex or mometasone furoate, an inhaled steroid controller medication for asthma, which means that unlike a metered dose inhaler your breath is what powers medication into the lungs.

Important Things To Remember About Your Amsmanex Twisthaler

For safety, it's important to know several things when you're using a Twisthaler, especially if you've just begun using it. 

  • The Twisthaler is not a rescue inhaler to be used for the treatment of acute asthma symptoms such as wheezing, chest tightness, cough and shortness of breath.
  • The Twisthaler is a maintenance medication used for the control and prevention of asthma symptoms. It needs to be used daily even when you are symptom free.
  • Patient information from the product’s website suggests taking the medication at the same time daily. However, if you realize you missed a dose take the missed dose as soon as possible. It is also a good idea to develop a plan with your doctor about what to do about missed doses.
  • Develop a strategy for remembering to take your medication.
  • Most asthma action plans will combine a rescue medication and inhaled steroids to treat your asthma.
  • Monitoring your asthma symptoms is the only way to know if your asthma action plan is working.
  • The cap is very important to your Asmanex Twisthaler. Removing the cap is what decreases the dose counter so you know how many doses remain. Replacing the cap after dosing prevent moisture from getting into your inhaler.
  • You may not taste, smell, or feel the medication entering your lungs. This is why it is very important to understand how the Twisthaler works. Do not give extra doses of medication unless instructed by your doctor.

How To Use an Amsmanex Twisthaler

The Amsmanex Twisthaler is a DPI and can be prescribed from 7- 120 doses of medication per inhaler. The counter indicates the number of doses left and the DPI should be discarded when the counter reaches zero. It is also recommended that the inhaler be discarded after 45 days regardless of whether doses remain. An instructional video is available on the Asmanex site.

The first time you use the Twisthaler it will need to be removed from the foil pouch it comes in. Write the date on the top of the inhaler so that you will know when you are 45 days from the start date.

  1. Remove the cap.  Make sure the Twisthaler is upright (with the pink or gray base at the bottom) when you remove the cap. Cap removal will cause the counter to decrease by one and make sure medication is ready for dosing. In order to remove the cap you should twist the cap upward in a counter-clockwise fashion. There is an arrow on the inhaler that indicates where the counter is.

  2. Breathe out fully before inhaling medication via Twisthaler Turn your head away from the Twisthaler and breathe out as much as you comfortably can. Do not breathe directly into the Twisthaler.

  1. Seal your lips tightly around the Twisthaler. This will ensure medication is fully inhaled. The Twisthaler should be on its side or horizontal. Make sure not to cover ventilation holes on the side of the inhaler.

  2. Inhale deeply and rapidly. Take as deep a breathe in as possible completely filling your lungs. Remove the Twisthaler from your mouth upon full inhalation.

  3. Hold your breath for a count of 10.

  4. Slowly breathe out and resume normal breathing. Do not breathe out into the Twisthaler.

  5. Close the Twisthaler by replacing the cap. The indented arrow on the cap should line up with the dose counter or you have not placed the cap back on correctly. You should also hear a click when done correctly. This is very important as this is how you know the next dose of medication is ready.

  1. Repeat steps 1–7 if you need more than one dose.

  2. Rinse your mouth out with water, gargle for a few seconds and spit out the water. This is important to prevent common side effects of inhaled steroids.

Twisthaler Side Effects

The risk of developing side effects with this inhaled steroid is not significantly different from any other inhaled steroid. As with any medication, there is a chance of side effects, but the benefits outweigh any risks for most people.

There are both local and system side effects that are possible. Local side effects include things like thrush, cough, or an altered voice. Systemic side effects include an increased risk of some infections, poor bone health, and poor growth in children. All of the side  effects are manageable, preventable, and need to be balanced by what the consequences of poor asthma control are.

What If I Cannot Afford My Inhaler?

If you are not able to afford your inhaler it does not mean that you are going to be saddled with poor breathing. You might want to consider looking into several different assistance programs for help with your medication costs. These programs run the gamut of patient assistance.

Additionally, you may want to look into other health insurance options. With many states implementing the Affordable Care Act, insurance has never been more wide open for patients.

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National Heart, Lung, and Blood Institute. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma.

Merck & Co., Inc. Asmanex Prescribing Information.

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