Children's Hospital Colorado
Breathing Institute
Breathing Institute

How to Use a Twisthaler Video

How to Use a Twisthaler

The Twisthaler puts a very fine dry powder into the lungs. You must take a deep and forceful breath in for the powder to reach your lungs.

When you get a new Twisthaler, remove it from the foil pouch and write the date on the cap. The Twisthaler will need to be thrown away 45 days after it is opened or when the dose counter reads "00."


  1. Hold the Twisthaler upright, with the pink or grey base at the bottom. Twist the cap counter-clockwise (to the left) to remove it.
  2. When you twist and lift off the cap, the dose counter will go down by one and the medicine will be loaded into the device. The medicine is now ready to be inhaled (breathed in).
  3. Turn away from the Twisthaler and breathe out.
  4. Hold the Twisthaler flat (horizontally) and place the mouthpiece in your mouth and seal your lips around it.
  5. Breathe in fast and deep through your mouth until your lungs are full.
  6. Hold your breath for 10 seconds. Then breath out normally.
  7. Put the cap back on and twist clockwise (to the right) until you hear it click and close.
  8. Repeat steps 3 through 7 for each dose ordered.
  9. Brush your teeth and rinse your mouth after each use.

How to care for your Twisthaler

Use a dry cloth to wipe the mouthpiece after use. Never get the Twisthaler wet.

The Twisthaler has a dose counter that counts down the dose by itself when the cap is removed. This also loads the dose of medicine. When the counter reads "00" there is no medicine left in the Twisthaler, throw it out and get a refill from the pharmacy.

  1. Keep your Twisthaler in a dry place at room temperature.
  2. Never breathe INTO the mouthpiece.
  3. Never use a spacer with your Twisthaler.
  4. Don’t lose the cap or you won’t be able to load the device with medicine.

Unlike other inhaled medicines, you may not taste or feel the dry powder. You may not know if the medicine is getting into your lungs. As long as you follow the directions, you will get the full dose of medicine.

Download instructions on how to use a Twisthaler (.pdf)


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