HOW TO USE:

1. Remove mouth piece

2. Hold puffer upright and shake well

**Prime puffer by wasting 2-3 puffs into the air if it has not been used for 1 week or is new.

3. Breathe out

4. Tilt the chin up to open the airways

5. Put the puffer mouth piece in mouth and create seal with lips

6. Start to breath in through mouth, then fire one puff and continue to breathe steadily and deeply

7. Remove puffer from mouth, close mouth and hold breath for 10 seconds.

8. Breath out gently away from the mouth piece

9. Replace mouth piece.

*CLEANING (once a week, Tilade/Intal everyday)

1. Remove metal canister. Do not place in water.

2. Wash the plastic casing only. Rinse mouthpiece through top and bottom with warm running water for at least 30 sec (1min each for through both ends for Intal/Tilade).

3. Shake excess water. Allow to airdry (if needed before dry, prime with 2-3 puffs)

4. Reassemble

******OR*******

Clean mouth piece with dry tissue if using Alvesco, Qvar, Seretide or Flixotide after each use (at least once a week)

1. Remove cover from Autohaler mouth piece.

2. Shake Autohaler to mix medication and propellant (not necessary for QVAR).

3. Hold Autohaler in upright condition without blocking vents at base.

4. Lift grey lever at the top of the device.

5. Breath out, tilt chin up, put mouth piece in mouth, form seal with lips.

6. Breath in through the mouth steadily and deeply. The Autohaler will fire a dose of medication automatically.

7. Remove autohaler, close mouth and hold breath for 10 seconds.

8. Breath out gently away from the mouth piece.

***In new or not used for two weeks, prime with 4 sprays usine lever on the bottom.

Cleaning (1/week, or more if necessary)

1. Remove cap, clean mouthpiece with clean dry cloth.

2. Turn upside down so that the flap comes down.

3. Use cotton tip to clean flap surface. DO NOT STICK ANYTHING IN HOLE, EG. PIN)

4. Put mouthpiece cap on, make sure lever is down.

1. Unscrew the cap and remove it.
2. Hold the Turbuhaler upright and twist the base to the right and back to the left. You will hear it click.
3. Breathe out gently taking care not to breathe into the Turbuhaler.
4. Put the mouthpiece in your mouth and form a seal with your lips.
5. Breathe in through the mouth forcefully and deeply for about 5 seconds.
6. Remove the Turbuhaler from your mouth while holding your breath for up to 10 seconds.
7. Breathe out gently away from the Turbuhaler.
8. If further doses are needed, repeat steps 2 to 7.
9. Replace cap.

• Hold the Accuhaler at its base using one hand  WHILE LEVEL
• Put your thumb of the other hand on the thumb grip
•  Open the Accuhaler by pushing the thumb grip around until you hear it click
• Slide the lever until it clicks  (Your medication is now loaded)
• Breathe out, away from the Accuhaler
• Put the mouthpiece in your mouth and form a good seal with your lips
• Breathe in through your mouth for up to 5 seconds
• Remove the Accuhaler from mouth whilst holding your breath for up to 10 seconds
• Breathe out gently away from the Accuhaler
• If further doses are required, push the lever back to the starting position and repeat the above steps
• Close the Accuhaler

HOW TO USE (how to administer 1 dose)

Open dust cap

Open mouthpiece

Remove capsule from blister (only immediately before use) and place in chamber

Close mouthpiece until it clicks

Press green piercing button in once and release

Breathe out gentley away from mouthpiece

Put mouthpiece in mouth forming a seal with the lips (without biting)

Breathe in slowly and deeply, so capsule vibrates

Continue to breathe in as long as comfortable

While holding breath, remove inhaler from mouth

Breathe out gently away from mouthpiece

Repeat last 5 steps to recieve the FULL dose.

Open mouthpiece and remove used capsule

Close mouthpiece

CLEANING INHALER (do this about 1/month immediately of administiring dose)

1. Open dust cap and mouthpiece

2. Then open base by lifting the green piercing botton

3. Rinse with warm water, then tip out excess water, leave to dry with device opened up

*** If needed, clean outside of mouthpiece with moist but not wet tissue

HOW TO USE A PEAK FLOW METER

1. Stand up

2. Hold the peak flow meter level, so that the indicator faces upwards. Make sure the indicator is on zero or 'start'.

3. Take in as deep a breath as possible

4. Place your lips tightly around the mouthpiece and blow as hard and fast as you can

5. Check your score on the meter

6. Repeat steps 1-5 two more times.

7. Record the highest score out of the three scores

*Always use the same peak flow meter

1. Assemble spacer

2. Remove inhaler cap

3. Hold inhaler upright and shake well

4. Insert inhaler upright into spacer

5. Put mouthpiece between teeth without biting and close lips to form good seal

6. Breathe out gently

7. Hold spacer level and press down firmly on canister once

8. Breathe in and out normally for 3-4 breaths*

9. Remove spacer from mouth

10. Breathe out gently away from mouthpiece

11. Remove inhaler from spacer

12. If an extra dose is needed, wait 1 minute and then repeat steps 3 to 11

13. Replace cap and disassemble spacer

CARING FOR YOUR SPACER.

*Clean your spacer before first use and then about once a month

*Wash with warm water with kitchen detergent and allow to air dry without rinsing

*Wipe mouthpiece clean of detergent before use

*Have spacer checked by doctor, pharmacist or nurse every 6-12 months to check structure is intact and the valve is working

1. Pull off the cap of the Aerolizer inhalation device.

 2. To open the capsule chamber, hold the base of the device firmly and turn the mouthpiece in the direction shown by the arrow.

 3. Make sure your fingers are completely dry, so that the capsule does not get wet, remove the capsule from the foil pack immediately before you are going to use it.

 4. Do not swallow the capsule.

The powder in the capsule is to be used for inhalation only.

 5. Place the capsule flat on the bottom of the capsule-shaped slot.

 6. Close the capsule chamber by twisting the mouthpiece back until you hear the "click" at the closed position.

 7. To pierce the capsule, hold the Aerolizer upright and firmly squeeze the two blue buttons at the same time and then release.

Pierce the capsule only once.

Note that if you pierce it more often, the capsule may break and small pieces of gelatin from the capsule shell may be inhaled into your mouth or throat. However the gelatin is edible and is not harmful.

 8. While holding the Aerolizer in an upright position, open the mouthpiece again and make sure that the capsule is loose in the slot so that when you inhale, the capsule is able to spin around in the circular area above the slot.

 9. Close the mouthpiece.

 10. Breathe out fully (as far as you can).

 11. Place the mouthpiece in your mouth and tilt your head slightly backwards.

 12. Close your lips firmly around the mouthpiece and then breathe in quickly but evenly, as deep as you can. Note that you should hear a whirring noise as the capsule spins around in the space above the capsule chamber. If you do not hear this noise, open the capsule chamber and check that the capsule lies loose in the capsule chamber. Then repeat step 11. DO NOT try to loosen the capsule by pressing the buttons repeatedly.

 13. After breathing in through the Aerolizer, hold your breath for as long as you comfortably can.

 14. Take the Aerolizer out of your mouth, and then breathe out through your nose.

 15. Open the capsule chamber to check whether there is any powder left in the capsule. If there is, repeat steps 10 to 15.

 16. After you have used up all the powder in the Aerolizer, open the capsule chamber and remove the empty capsule.

 17. Check the Aerolizer to see if there is any dry powder remaining in the device.

 18. To remove any remaining powder, wipe the mouthpiece and capsule slot with a dry cloth or a clean soft brush. DO NOT USE WATER TO CLEAN MOUTH PIECE

19. Close the mouthpiece and put the cap on again.

Storage

Keep your capsules in the foil packs inside the cardboard carton until it is time to use them.

Store the capsules in a cool dry place at or below 25°C.

Do not store Foradile or any other medicine in the bathroom or near a sink.

Do not leave it in the car or on window sills.

How to load the Intal Spinhaler

First make sure your hands are clean and dry.

Inspect mouthpiece for any foreign objects or dust.

Tear open the sachet and press out a Spincap through the foil.

Load the Spinhaler as follows:

1. Hold the Spinhaler upright with the mouthpiece pointing downwards; then unscrew the body. 

2. Check that the propeller is on its spindle, then firmly push an Intal Spincap (coloured end downwards) into the cup of the propeller. Make sure that the propeller spins easily and then screw the body tightly back onto the mouthpiece. 

3. Still holding the Spinhaler upright, slide the outer sleeve down as far as it will go and then back up again. This pierces the Spincap and makes the Spinhaler ready for use. This step may be repeated a second time for optimal piercing.

How to inhale Intal

1. Make sure the mouthpiece and the body of the Spinhaler are still tightly screwed together. 

2. Breathe out, put the mouthpiece in your mouth and close your lips around it so that they are right up against the lip of the Spinhaler. 

3. Tilt your head well back and breathe in as deeply as you can. This is very important. 

4. Hold your breath for as long as comfortable, then take the Spinhaler right out of your mouth and breathe out. 

5. Keep repeating this process until the Spincap is empty. Two or three attempts should be enough and it does not matter if a little powder is left. 

6. If you have a little irritation in your throat afterwards, have a drink of water.

How to look after your Spinhaler

1. Remove the snap fit propeller;

2. Wash in warm water;

3. Dry overnight in a warm place;

4. Click propeller firmly back into place before re-using it.

How to store

Keep blisters in pack until it's time to use them

Store blisters in cool dry place <30C

Keep Spinhaler in its container to keep clean and ready for next use.

DO NOT leave in car or window sill

1. Connect the power supply

2. Fill nebuliser bowl with at least 2.5-5ml solution. Dilute with normal saline if necessary.

3. Connect tubing to the air supply output.

4. Connect tubing to the medication.

5. Attach medication to holder to face mask or mouthpiece

6. Place mask on your face.

7. Hold each breath for 1-2 seconds before breathing out.

8. Continue until all medicine is gone. NB: if it takes longer than this the device may be blocked/cracked.

Cleaning and storage

Bowl - rinse after each use with warm water. After, connect tubing and and switch pump on to blow air through it for a few seconds to dry it. ***Replace bowl if it starts to leak or every 3 months.

Mask - rinse twice a week.

Tubing - does not require washing. Replace if cracks appear or every 3 months.

Filters - replace every 3-6months.

Unit - serviced every 6-12months

Notes

Use barrier cream to prevent/treat rash.

Cover eyes if using atrovent/corticosteroids - goggles

Some medications can be mixed with others.

Do not share with any other person.

1. Pull of blue cover

2. Check inside mouthpiece to make sure it is clear before each use.

3. Pull white mouthpiece by the edges to extend the white tray all the way.

4. Press on raised ridges and pull the whole tray out of the diskhaler.

5. Place silver medicine disk onto dark brown wheel, flat side up.

6. Push the white tray back into diskhaler as far as it will go.

7. Keep diskhaler level so medicine does not spill out.

8. Lift half-circle flap until it can't go any further - straight up. This action punctures the blister.

9. Lift flap down, back into place.

10. Breath all the way out, then put white mouth piece in mouth.

11. Close your lips firmly around the mouthpiece (do not cover small holes on either side), breathe in as deep as you can.

12. Hold your breath for a few seconds.

13. Take another inhalation.

14. Pull the mouthpiece to extend the white tray, without removing it.

15. Push the mouthpiece back until it clicks.

16. Take your next inhalation (repeat steps 10-13)

Cleaning and Storage

Clean mouthpiece once a week with a dry cloth or tissue.

Store in dry place, away from direct heat or sunlight. Do not leave in the car or on window sills.

Preparing Novopen4

1. Pull of the cap

2. Unscrew the penfill holder (cartridge holder)

3. Push in the piston rod gently until it stops

Loading new cartridge

4. Remove cartridge from wrapper by pushing it through the foil side

5. Check that cartridge is full and intact, with no cracks. *rapid and short acting and detemir, glargine should be clear.

6.  If using cloudy insulin (Novomix 30) resuspend by rolling cartridge between hands 10 times, then turning cartridge upside down and back upright at least 10 times.

NB: For subsequent uses of cloudy insulin, turn upside down and back upright while in pen. There should be at least 12 units left in the cartridge.

7. Insert the penfill cartridge into the cartridge holder, coloured cap first. NB: You can see how much insulin is left through the cartridge window.

8. Screw the cartridge into the Novopen until you hear or feel a click.

9. Whipe the rubber stopper with an alcohol swab.

10. Remove the protective tab from a Novofine disposable needle. Screw the needle tightly onto the coloured cap.

11. Pull of the outer cap. Carefully pull of the inner needle cap and throw it away.

AIR SHOT

12. Pull out the dose button.

13. Turn the dose button to select 4 units (for new cartridge), 1 unit (if the cartridge is already in use)

14. Hold your Novopen with needle pointing up. Tap the cartridge holder gentley with your finger to make the any air bubbles collect at the top of the cartridge.

15. Press dose button all the way in until you hear or feel a click. A drop of insulin must appear at the needle tip. Repeat these steps until this does happen. If no insulin is seen after 6 attempts, do not use the pen.

GIVE INJECTION

16. Pull out button, select dose.

17. Insert needle into skin. Pinching skin will increase chance that the injection will be SC.

18. Press button.

19. Keep the needle in the skin for 6 sec.

20. Remove needle from skin and immediatley replace the outer needle cap onto the needle. Hold the cartridge holder and unscrew the needle, then remove needle and put in sharps bin.

21. Replace Novopen cap.

Notes:

Do not put needle on pen until you are ready to do an air shot and take your injection.

Do not share your Novopen with other diabetics.

1. Pull of the cap.

2. Unscrew the cartridge holder and remove from body.

3. Insert small end of cartridge into the cartridge holder.

4. Push cartridge holder into pen and screw together until secure.

5. For cloudy insulin, roll 10 times, invert 10 times.

6. Remove paper tab of needle, attach needle.

7. Remove outer and inner needle cap.

8. Prime the pen by dialing 2 units, pointing the pen up, and tapping any air bubbles to the top of the pen.

9. Push the injection button, looking for a stream of insulin. The pen is not properly primed if you only see a few drops of insulin. Several prime attempts may be needed the first time a cartridge is used, to allow the gap between the screw and cartridge plunger to close.

10. Dial injection dose, inject, check to see if dial is at 0 to confirm dose was given.

11. Replace outer needle cap, unscrew needle and dispose of into sharps container.

12. Replace pen cap.