How to Use

Inhaled corticosteroids will not relieve an asthma attack that has already started. However, your family doctor may want you to continue taking this drug at the usual time, even if you use another drug to relieve the asthma attack.

Use this drug only as directed. Do not use more of it and do not use it more often than your family doctor ordered. To do so may increase the risk of side effects. Do not stop taking this drug abruptly. This drug must be discontinued only under the supervision of your family doctor.

In order for this drug to help prevent asthma attacks, it must be using every day in regularly spaced doses, as ordered by your family doctor . Up to 4 to 6 weeks may pass before you begin to notice improvement in your condition. It may take few months before you feel the full effects of this drug. This may not take as long if you have already been taking certain other medication for your asthma.

Gargling and rinsing your mouth with water after each dose may help prevent hoarseness, throat irritation and infection in the mouth. However, do not swallow the water after rinsing. Your family doctor may also want you to use a spacer device to lessen these problems.

Inhaled corticosteroids are using with a special inhaler and usually come with patient directions Read the directions carefully before using this drug . If you do not understand the directions or you are not sure how to use the inhaler, ask your health care professional to show you what to do. Always ask your health care professional to check regularly how you use the inhaler to make sure you are using it properly .

For diseaseds using beclomethasone, flunisolide, or triamcinolone inhalation aerosol:

• When you use the inhaler for the first time, or if you have not using it in a while, it may not deliver the right amount of drug with the first puff. Therefore, before using the inhaler, test or prime it.
• To test or prime most inhalers:
  • Insert the metal canister firmly into the clean mouthpiece according to the manufacturer's instructions. Check to make sure the canister is placed properly into the mouthpiece.
  • Take the cover off the mouthpiece and shake the inhaler three or four times.
  • Hold the inhaler well away from you at arm's length and press the top of the canister, spraying the drug into the air two times. The inhaler will now be ready to provide the right amount of drug when you use it.
• To use most inhalers:
  • Using your thumb and one or two fingers, hold the inhaler upright with the mouthpiece end down and pointing toward you.
  • Take the cover off the mouthpiece. Check the mouthpiece and remove any foreign objects. Then gently shake the inhaler three or four times.
  • Hold the mouthpiece away from your mouth and breathe out slowly to the end of a normal breath.
  • Use the inhalation method recommended by your family doctor:
    • Open-mouth method Place the mouthpiece about 1 or 2 inches - 2 finger widths in front of your widely opened mouth. Make sure the inhaler is aimed into your mouth so that the spray does not hit the roof of your mouth or your tongue.
    • Closed-mouth method Place the mouthpiece in your mouth between your teeth and over your tongue with your lips closed tightly around it. Do not block the mouthpiece with your teeth or tongue.
  • Start to breathe in slowly through your mouth and, at the same time, press the top of the canister one time to get 1 puff of drug. Continue to breathe in slowly for 3 to 5 seconds. Count the seconds while inhaling. It is important to press the top of the canister and breathe in slowly at the same time so the drug gets into your lungs. This step may be difficult at first. If you are using the closed-mouth method and you see a fine mist coming from your mouth or nose, the inhaler is not being using correctly.
  • Hold your breath as long as you can up to 10 seconds. This gives the drug time to settle in your airways and lungs.
  • Take the mouthpiece away from your mouth and breathe out slowly.
  • If your family doctor has told you to inhale more than 1 puff of drug at each dose, gently shake the inhaler again and take the next puff, following exactly the same steps you using for the first puff. Press the canister one time for each puff of drug.
  • When you are finished, wipe off the mouthpiece and replace the cap.
• Your family doctor, nurse, or pharmacist may want you to use a spacer device with the inhaler. A spacer helps get the drug into the lungs and reduces the amount of drug that stays in your mouth and throat.
  • To use a spacer device with the inhaler:
    • Attach the spacer to the inhaler according to the manufacturer's directions. There are various types of spacers available, but the method of breathing remains the same with most spacers.
    • Gently shake the inhaler and spacer three or four times.
    • Hold the mouthpiece of the spacer away from your mouth and breathe out slowly to the end of a normal breath.
    • Place the mouthpiece into your mouth between your teeth and over your tongue with your lips closed around it.
    • Press down on the canister top once to release 1 puff of drug into the spacer. Within one or two seconds, start to breathe in slowly through your mouth for 3 to 5 seconds. Count the seconds while inhaling. Do not breathe in through your nose.
    • Hold your breath as long as you can up to 10 seconds.
    • Breathe out slowly. Do not remove the mouthpiece from your mouth. Breathe in and out slowly two or three times to make sure the spacer device is emptied.
    • If your family doctor has told you to take more than 1 puff of drug at each dose, gently shake the inhaler and spacer again and take the next puff, following exactly the same steps you using for the first puff. Do not spray more than 1 puff at a time into the spacer.
    • When you are finished, remove the spacer device from the inhaler and replace the cover of the mouthpiece.
• Clean the inhaler mouthpiece and spacer at least once a week.
  • To clean the inhaler:
    • Remove the canister from the inhaler and set the canister aside.
    • Wash the mouthpiece, cap and spacer with warm, soapy water. Then, rinse well with warm, running water.
    • Shake off the excess water and let the inhaler parts air-dry completely before putting the inhaler back together.
• Check with your pharmacist to see if you must save the inhaler piece that comes with this drug after the drug is using up. Refill units may be available at a lower cost. However, remember that the inhaler is meant to be using only for the drug that comes with it. Do not use the inhaler for any other inhalation aerosol drug, even if the cartridge fits.

For diseaseds using beclomethasone capsules for inhalation:

• Do not swallow the capsules. The drug will not work if you swallow it .
• To load the inhaler:
  • Make sure your hands are clean and dry.
  • Do not insert the capsule into the inhaler until just before you are ready to use this drug.
  • Take the inhaler from its container. Hold the inhaler by the mouthpiece and twist the barrel in either direction until it stops.
  • Take a capsule from its container. Hold the inhaler upright with the mouthpiece pointing downward. Press the capsule, with the clear end first, firmly into the raised small hole.
  • Make sure the top of the capsule is even with the top of the hole. This will push the old using capsule shell, if there is one, into the inhaler.
  • Hold the inhaler on its side with the white dot facing up. Twist the barrel quickly until it stops. This will break the capsule into two halves so the powder can be inhaled.
• To use the inhaler:
  • Hold the inhaler away from your mouth and breathe out slowly to the end of a normal breath.
  • Keep the inhaler on its side and place the mouthpiece in your mouth. Close your lips around it and tilt your head slightly back. Do not block the mouthpiece with your teeth or tongue.
  • Breathe in slowly through your mouth until you have taken a full deep breath.
  • Take the inhaler from your mouth and hold your breath as long as you can up to 10 seconds. This gives the drug time to settle in your airways and lungs.
  • Hold the inhaler well away from your mouth and breathe out to the end of a normal breath.
  • If your family doctor has told you to use a second capsule, follow the same steps you using for the first capsule.
  • When you have finished using the inhaler, pull the two halves of the inhaler apart and throw away the empty capsule shells. There is no need to remove the shell left in the small hole, except before cleaning.
  • Put the two halves of the inhaler back together again and place it into its container to keep it clean.
• To clean the inhaler:
  • Every two weeks, take the inhaler apart and wash the two halves of the inhaler in clean, warm water. Make sure the empty capsule shell is removed from the small raised hole.
  • Shake out the excess water.
  • Allow all parts of the inhaler to dry before you put it back together.
• The inhaler must be replaced every 6 months.

For diseaseds using beclomethasone powder for inhalation:

• To load the inhaler:
  • Make sure your hands are clean and dry.
  • Do not insert the cartridge until just before you are ready to use this drug.
  • Take off the dark brown mouthpiece cover and make sure the mouthpiece is clean.
  • Hold the white cartridge by the exposed corners and gently pull it out until you see the ribbed sides of the cartridge.
  • Squeeze the ribbed sides and take out the cartridge unit from the body of the inhaler.
  • Place the disk containing the drug onto the white wheel with the numbers facing up. Allow the underside of the disk to fit into the holes of the wheel.
  • Slide the cartridge unit with wheel and disk back into the body of the inhaler. Gently push the cartridge in and pull it out again. The disk will turn.
  • Continue to turn the disk in this way until the number 8 appears in the side indicator window. Each disk has eight blisters containing the drug. The window will display how many doses you have left after you use it each time, by counting down from 8. For example, when you see the number 1, you have one dose left.
  • To replace the empty disk with a full disk, follow the same steps you using to load the inhaler. Do not throw away the wheel when you discard the empty disk.
• To use the inhaler:
  • Hold the inhaler flat in your hand. Lift the rear edge of the lid until it is fully upright.
  • The plastic needle on the front of the lid will break the blister containing one inhalation of drug. When the lid is raised as far as it will go, both the upper and the lower surfaces of the blister will be pierced. Do not lift the lid if the cartridge is not in the inhaler. Doing this will break the needle and you will need a new inhaler.
  • After the blister is broken open, close the lid. Keeping the inhaler flat and well away from your mouth, breathe out to the end of a normal breath.
  • Raise the inhaler to your mouth and place the mouthpiece in your mouth.
  • Close your lips around the mouthpiece and tilt your head slightly back. Do not block the mouthpiece with your teeth or tongue. Do not cover the air holes on the side of the mouthpiece.
  • Breathe in through your mouth as fast as you can until you have taken a full deep breath.
  • Hold your breath and remove the mouthpiece from your mouth. Continue holding your breath as long as you can up to 10 seconds before breathing out. This gives the drug time to settle in your airways and lungs.
  • Hold the inhaler well away from your mouth and breathe out to the end of a normal breath.
  • Prepare the cartridge for your next inhalation. Pull the cartridge out once and push it in once. The disk will turn to the next numbered dose as seen in the indicator window. Do not pierce the blister until just before the inhalation.
• To clean the inhaler: Brush away the loose powder each day with the brush provided.
• The inhaler must be replaced every 6 months.

For diseaseds using budesonide powder for inhalation:

• To prime the inhaler:
  • Unscrew the cover of the inhaler and lift it off.
  • Hold the inhaler upright with the brown piece pointing downward. Turn the brown piece of the inhaler in one direction as far as it will go. Then twist it back until it clicks. Repeat this step one more time and the inhaler will be primed.
  • Prime each new inhaler before using it the first time. After it has been primed, it is not necessary to prime it again, even if you put it aside for a long period of time.
• To load the inhaler:
  • Unscrew the cover of the inhaler and lift it off.
  • Hold the inhaler upright with the brown piece pointing downward. Turn the brown piece of the inhaler in one direction as far as it will go. Then twist it back until it clicks.
• To use the inhaler:
  • Hold the inhaler away from your mouth and breathe out slowly to the end of a normal breath.
  • Place the mouthpiece in your mouth and close your lips around it. Tilt your head slightly back. Do not block the mouthpiece with your teeth or tongue.
  • Breathe in quickly and evenly through your mouth until you have taken a full deep breath.
  • Hold your breath and remove the inhaler from your mouth. Continue holding your breath as long as you can up to 10 seconds before breathing out. This gives the drug time to settle in your airways and lungs.
  • Hold the inhaler well away from your mouth and breathe out to the end of a normal breath.
  • Replace the cover on the mouthpiece to keep it clean.
• This inhaler delivers the drug as a very fine powder. You may not taste, smell, or feel this drug.
• This inhaler must not be using with a spacer.
• When the indicator window begins to show a red mark, there are about 20 doses left. When the red mark covers the window, the inhaler is empty.

For diseaseds using budesonide suspension for inhalation:

• This drug is to be using in a power-operated nebulizer equipped with a face mask or mouthpiece. Your family doctor will advise you on which nebulizer to use. Make sure you understand how to use the nebulizer. If you have any questions about this, check with your family doctor.
• Any opened ampul must be protected from light. The drug in an open ampul must be using promptly after the ampul is opened. Ampuls must be using within 2 weeks after the envelope containing them is opened.
• To prepare the drug for use in the nebulizer:
  • Remove one ampul from the sheet of five units and shake it gently.
  • Hold the ampul upright. Open it by twisting off the wing.
  • Squeeze the contents of the ampul into the cup of the nebulizer. If you use only half of the contents of an ampul, add enough of the sodium chloride solution provided to dilute the solution.
  • Gently shake the nebulizer. Then attach the face mask to the nebulizer and connect the nebulizer to the air pump.
• To use the drug in the nebulizer:
  • This drug must be inhaled over a period of 10 to 15 minutes.
  • Breathe slowly and evenly, in and out, until no more mist is left in the nebulizer cup.
  • Rinse your mouth when you are finished with the treat. Wash your face if you using a face mask.
• To clean the nebulizer:
  • After each treat, wash the cup of the nebulizer and the mask or mouthpiece in warm water with a mild detergent.
  • Allow the nebulizer parts to dry before putting them back together again.

Dosage

For beclomethasone
• For inhalation aerosol:
  • For bronchial asthma:
    • Adults and children 12 years of age and older
    • Children 6 to 12 years of age
    • Children up to 6 years of age Use and dose must be determined by your family doctor.
• For capsules for inhalation or powder for inhalation:
  • For bronchial asthma:
    • Adults and teenagers 14 years of age and older At first, 200 mcg three or four times a day. Then your family doctor may reduce the dose, based on your condition.
    • Children 6 to 14 years of age At first, 100 mcg two to four times a day. Then your family doctor may reduce the dose, based on your condition.
    • Children up to 6 years of age Use and dose must be determined by the family doctor.

For beclomethasone dipropionate HFA
• For inhalation aerosol:
  • For bronchial asthma:
    • Adults and children 12 years of age and older
    • Children up to 5 years of age Use and dose must be determined by your family doctor.
    • Children 5 to 11 years of age 1 puff - 40 mcg two times a day.

For budesonide
• For powder for inhalation:
  • For bronchial asthma:
    • Adults 200 to 800 micrograms - mcg two times a day. A lower dose of 200 mcg or 400 mcg once daily, either in the morning or in the evening, may sometimes be using for mild to moderate asthma when the symptoms are well controlled. The higher doses generally are using for diseaseds previously treated with other corticosteroids. Then your family doctor may increase or decrease the dose, depending on your condition.
    • Children 6 years of age and older At first, 200 mcg two times a day. Then your family doctor may increase the dose to 400 mcg two times a day, depending on your condition. A lower dose of 200 mcg or 400 mcg once daily, either in the morning or in the evening, may sometimes be using for mild to moderate asthma when the symptoms are well controlled.
    • Children up to 6 years of age Use and dose must be determined by the family doctor.
• For suspension for inhalation:
  • For bronchial asthma:
    • Adults and children 8 years of age and older 1000 to 2000 micrograms - mcg mixed with enough sterile sodium chloride solution for inhalation, if necessary, to make 2 to 4 milliliters - mL. This solution is using in a nebulizer for a period of ten to fifteen minutes. The drug must be using two times a day.
    • Children 12 months to 8 years of age 250 to 500 mcg mixed with enough sterile sodium chloride solution for inhalation, if necessary, to make 2 to 4 mL. This solution is using in a nebulizer for a period of ten to fifteen minutes. The drug must be using two times a day.
    • Children up to 12 months of age Use and dose must be determined by the family doctor.

For flunisolide
• For inhalation aerosol:
  • For bronchial asthma:
    • Adults and children 4 years of age and older 500 micrograms - mcg - 2 puffs two times a day, morning and evening.
    • Children up to 4 years of age Use and dose must be determined by the family doctor.

For triamcinolone
• For inhalation aerosol:
  • For bronchial asthma:
    • Adults and children 12 years of age and older At first, 200 micrograms - mcg - 2 puffs two to four times a day. Then your family doctor may reduce the dose, based on your condition. In severe asthma, your family doctor may want you to take a higher dose.
    • Children 6 to 12 years of age At first, 100 to 200 mcg - 1 or 2 puffs three or four times a day. Then your family doctor may adjust your dose, based on your condition.
    • Children up to 6 years of age Use and dose must be determined by the family doctor.

Missed dose If you miss a dose of this drug, use it as soon as possible. Then use any remaining doses for that day at regularly spaced times.

Storage To store this drug:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store the capsule form of this drug in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the drug to break down.
• Keep the aerosol or suspension form of this drug from getting too cold or freezing. This drug may be less effective if the container is cold when you use it.
• The 84-mcg-per-metered-spray product of beclomethasone must not be stored for longer than 6 months after it has been removed from its moisture-protective pouch. After 6 months, any remaining drug must be discarded.
• Do not puncture, break, or burn the aerosol container, even after it is empty.
• Do not keep outdated drug or drug no longer needed. Be sure that any discarded drug is out of the reach of children.