Mastering Your Health: How to Use a Breathing Capsule Correctly

Studies show that between 4% and 94% of patients do not use their dry powder inhalers correctly, potentially reducing the medication's effectiveness [1.6.2]. Learning how to use a breathing capsule properly is crucial for managing respiratory conditions like asthma and COPD.

Quick Summary

Properly using a breathing capsule with a dry powder inhaler involves loading the capsule, piercing it, and inhaling the medication deeply. Correct technique ensures the full dose reaches your lungs for optimal treatment of asthma or COPD.

Key Points

• What It Is: A 'breathing capsule' is used with a Dry Powder Inhaler (DPI) to deliver medication for conditions like asthma and COPD [1.4.6, 1.3.4].

• Preparation is Key: Always start with clean, dry hands and only remove one capsule from its blister pack right before use to avoid moisture damage [1.7.3, 1.6.6].

• Proper Loading and Piercing: Place the capsule in the designated chamber, close the device until it clicks, and press the piercing button(s) only once [1.7.2, 1.8.4].

• Correct Inhalation Technique: Exhale completely away from the device, then inhale forcefully and deeply through your mouth, listening for the capsule to rattle [1.7.2, 1.7.6].

• Hold and Repeat: Hold your breath for 5-10 seconds after inhaling. A second inhalation is often needed to empty the capsule completely [1.8.2, 1.2.2].

• Device Care: Never wash a DPI device with water; wipe the mouthpiece with a dry cloth. Store in a cool, dry place [1.5.5, 1.6.4].

• Avoid Common Errors: Common mistakes include not exhaling first, not inhaling forcefully enough, and piercing the capsule more than once [1.6.2, 1.8.4].

Understanding Breathing Capsules and Dry Powder Inhalers (DPIs)

"Breathing capsule" is a common term for the medication capsules used in a specific type of device called a Dry Powder Inhaler (DPI) [1.4.6]. These devices are prescribed for respiratory conditions like Chronic Obstructive Pulmonary Disease (COPD) and asthma [1.3.4]. Unlike metered-dose inhalers (MDIs) that propel a spray of medication, DPIs contain the medicine in a dry powder form within a capsule [1.4.1]. The patient's own breath is what aerosolizes and delivers the powder deep into the lungs [1.4.1].

These systems were designed to overcome some challenges of traditional inhalers, such as the need for coordinating actuation and inhalation [1.4.1]. The medication inside these capsules is typically a bronchodilator or a corticosteroid, which helps to relax the muscles around the airways or reduce inflammation [1.3.2, 1.3.4]. Common examples of capsule-based DPIs include the HandiHaler® (used for Spiriva) and the Aerolizer® (used for Foradil) [1.4.2, 1.4.5].

Step-by-Step Guide: How to Use a Breathing Capsule

Proper technique is essential for the medication to be effective. While specific steps can vary slightly between devices like the HandiHaler and Aerolizer, the general process is consistent. Always refer to the instructions provided with your specific device.

Preparation:

1. Wash Your Hands: Begin with clean, dry hands to handle the capsule and device.
2. Prepare the Device: Open the inhaler's dust cap and mouthpiece [1.2.1]. The specific way to open it will depend on your device model.
3. Retrieve ONE Capsule: Remove only one capsule from its blister pack immediately before use [1.7.2]. Storing capsules outside their packaging can expose them to moisture, making them less effective [1.6.6]. Do not swallow the capsule [1.7.6].

Loading and Piercing:

4. Insert the Capsule: Place the capsule into the capsule chamber located in the base of the inhaler [1.7.3]. Do not place it directly into the mouthpiece [1.8.4].
5. Close the Mouthpiece: Close the mouthpiece firmly until you hear a click. This secures the capsule in place [1.7.2].
6. Pierce the Capsule: Hold the inhaler upright and press the piercing button(s) firmly once and release [1.8.3, 1.7.2]. You should hear a click. This action creates holes in the capsule, allowing the medication to be released when you inhale [1.8.4]. Do not press the button more than once, as this can shatter the capsule [1.8.4].

Inhalation:

7. Exhale Completely: Breathe out fully, away from the inhaler's mouthpiece [1.7.2]. This empties your lungs, making room for a deep inhalation.
8. Inhale Deeply and Steadily: Place the mouthpiece between your teeth and close your lips to create a tight seal. Breathe in quickly and deeply [1.8.2]. You should hear or feel the capsule vibrate or "rattle" inside the chamber; this sound confirms you are inhaling correctly and the medication is being dispersed [1.7.6].
9. Hold Your Breath: Remove the inhaler from your mouth and hold your breath for 5 to 10 seconds, or as long as is comfortable [1.8.2, 1.7.3]. This allows the medication to settle in your lungs.
10. Exhale Slowly: Breathe out gently, away from the inhaler [1.2.1].
11. Check the Capsule: Open the mouthpiece and check if there is powder remaining in the capsule. If so, repeat steps 7 through 10 to ensure you receive the full dose [1.8.2]. Most devices recommend two inhalations per capsule [1.2.2].

After Use:

12. Discard the Capsule: Once empty, open the device, remove the used capsule, and discard it [1.2.3].
13. Clean and Store: Close the inhaler. If needed, wipe the mouthpiece with a dry cloth. Never wash a DPI device with water, as moisture can cause the powder to clump [1.5.5]. Store the inhaler and capsules in a cool, dry place [1.6.4].

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Comparison of Common Capsule Inhaler Devices

Feature	HandiHaler (e.g., Spiriva)	Aerolizer (e.g., Foradil)
Piercing Mechanism	Single green button on the side presses once [1.7.2].	Two buttons on opposite sides are pressed simultaneously once [1.8.3].
Loading	Lift dust cap, then mouthpiece. Place capsule in center chamber [1.7.3].	Twist mouthpiece to the side. Place capsule in the shaped well [1.8.3].
Inhalation Feedback	Capsule vibrates or "rattles" [1.7.6].	Capsule vibrates or "rattles" [1.8.1].
Recommended Inhalations	Two inhalations per capsule are typically needed to get the full dose [1.7.6].	Check capsule for remaining powder; repeat inhalation if needed [1.8.2].
Cleaning	Can be rinsed with warm water and air-dried for 24 hours. The base can be opened for cleaning [1.7.1].	Should not be washed. The mouthpiece can be wiped with a dry cloth [1.8.3].

Common Mistakes and Troubleshooting

Even with a seemingly simple device, errors are common. Being aware of these can significantly improve your treatment's effectiveness.

• Not Exhaling Before Inhalation: This is one of the most frequent errors and prevents a deep enough breath to pull the medication into the lungs [1.6.2].
• Not Inhaling Forcefully Enough: DPIs are breath-actuated. A weak inhalation won't be sufficient to aerosolize the powder effectively [1.6.2].
• Inhaling Through the Nose: The medication must be inhaled through the mouth.
• Piercing the Capsule Multiple Times: This can cause the capsule to break into small pieces [1.8.4]. While inhaling small gelatin or HPMC fragments is generally considered harmless, it should be avoided [1.6.4].
• Forgetting the Second Inhalation: Many users don't realize that a second inhalation is often required to empty the capsule [1.2.2, 1.7.5].

If you don't hear the capsule rattle, it might be stuck. You can gently tap the base of the inhaler to loosen it before trying to inhale again [1.2.4].

Conclusion

Using a breathing capsule inhaler is a skill that directly impacts the management of respiratory diseases. By following a precise, step-by-step process—from loading and piercing the capsule to the specifics of inhalation and breath-holding—patients can ensure they receive the full therapeutic dose. Understanding the differences between devices, recognizing common errors, and performing regular cleaning and proper storage are all critical components of successful treatment. If you have any doubts about your technique, consult your doctor or pharmacist for a demonstration.

For more information from an authoritative source, you can visit the National Asthma Council Australia.

Frequently Asked Questions

What is a breathing capsule?

A breathing capsule contains medication in a dry powder form for use in a specific device called a Dry Powder Inhaler (DPI). These are commonly prescribed for respiratory conditions like asthma and COPD [1.4.6, 1.3.4].

Can I swallow the breathing capsule?

No, you must never swallow the capsule. The medication is designed to be inhaled into the lungs using the specific inhaler device [1.7.6].

Why do I need to inhale twice from one capsule?

A single inhalation may not be enough to empty all the fine powder from the capsule. A second inhalation helps ensure you receive the full, prescribed dose of medication [1.2.2, 1.7.5].

What should I do if I don't hear the capsule rattle when I inhale?

If you don't hear a rattling sound, the capsule may be stuck. Open the device and gently tap its base to loosen the capsule, then close it and try inhaling again [1.2.4].

How should I clean my capsule inhaler?

You should never use water to clean a dry powder inhaler as it can damage the medication. Wipe the mouthpiece with a clean, dry cloth as needed. Some specific models like the HandiHaler may have different instructions allowing for rinsing, so always check your device's leaflet [1.5.5, 1.7.1].

Is it harmful to inhale small pieces of the capsule?

Inhaling small fragments of the capsule (made of gelatin or HPMC) is generally considered harmless. The pieces are usually too large to reach the lungs. This can be minimized by piercing the capsule only once and storing it correctly [1.6.4, 1.8.4].

How should I store my breathing capsules and inhaler?

Keep the capsules in their original blister pack until you are ready to use them. Store both the capsules and the inhaler in a cool, dry place, away from direct sunlight and moisture [1.6.4, 1.7.3].