One of the medications used for chronic obstructive pulmonary disease (COPD), tiotropium (Spiriva), is used only with a HandiHaler. This is a type of dry powder inhaler.

You use this inhaler as follows:

1. Hold the HandiHaler with the dust cap pointing up. Open the dust cap and then the mouthpiece.
2. Remove a Spiriva capsule from the blister package, and place it in the center chamber. Do not swallow the capsule.
3. Close the mouthpiece. You will hear a click when it is correctly closed.
4. Press in the green button completely one time. This makes holes in the capsule so the medication will be released. Note: Do not handle the Spiriva capsule after it has been punctured. If you do need to handle a punctured capsule, wash your hands thoroughly. Keep your hands away from your eyes until you have washed your hands.
5. With your mouth away from the inhaler, breathe out completely. Never breathe out through the inhaler.
6. Tilt the mouthpiece to the side and close your lips tightly around it.
7. Breathe in slowly and deeply, but hard enough so that you can hear the capsule vibrate. Breathe in until you can't breathe any more.
8. Take the HandiHaler out of your mouth and hold your breath as long as it's comfortable. Then breathe out.
9. Repeat steps 5, 6, and 7. This will empty the capsule.

Open the mouthpiece and tip out and throw away the used capsule. Close the mouthpiece and dust cap.

Rinse the HandiHaler once a month in warm water. You will need to push up on the green button to expose the center chamber. After rinsing, dry the inhaler by tipping water out and air drying. Leave the dust cap, mouthpiece, and piercing chamber open. It takes 24 hours to completely dry the inhaler.

You can use the HandiHaler for up to 1 year.

Keep the Spiriva capsules in the blister package until right before you use them.