The Asmanex Twisthaler is a dry powder inhaler that delivers a steroid medication (mometasone furoate) directly into your lungs to control asthma symptoms. Unlike a traditional metered-dose inhaler, it doesn’t use a propellant spray. Instead, your own breath pulls the powder into your airways, which means your inhalation technique matters more than with most inhalers.
How the Twisthaler Works
The device has a twist-off cap that also loads each dose. When you remove the cap by twisting it counterclockwise, the inhaler automatically meters out a precise amount of powder into the chamber. When you replace the cap by twisting it clockwise, the built-in dose counter clicks down by one. This means every time you open and close the cap, one dose is used, whether you actually inhale it or not. Accidentally opening and closing the cap wastes a dose.
Step-by-Step Instructions
Hold the inhaler upright with the pink or colored base on the bottom. Twist the cap counterclockwise and lift it off. You’ll hear a click, which confirms the dose has loaded. Do not shake the device.
Before bringing the inhaler to your mouth, breathe out fully, away from the mouthpiece. You don’t want to exhale into the device because moisture from your breath can clump the powder and reduce how much medication reaches your lungs.
Place the mouthpiece in your mouth, holding the inhaler in a horizontal (sideways) position. Close your lips firmly around it so there are no gaps. Then take a fast, deep breath in. Unlike a metered-dose inhaler where slow and steady is best, a dry powder inhaler needs a rapid, forceful inhalation to pull the fine powder deep into your airways.
Remove the inhaler from your mouth and hold your breath for about 10 seconds, or as long as feels comfortable. This gives the medication time to settle onto your airway surfaces. Then breathe out slowly through your nose or pursed lips.
Replace the cap immediately by twisting it clockwise until it clicks. This keeps moisture out and resets the device for the next use.
Rinsing Your Mouth After Each Use
After every dose, rinse your mouth with water and spit it out, brush your teeth, or have a drink. The medication that lands in your mouth and throat doesn’t help your asthma and can cause oral thrush, a yeast infection that shows up as white patches on your tongue or inner cheeks. Rinsing removes the residual steroid and significantly reduces that risk.
Tracking Your Doses
The dose counter on the base of the inhaler counts down each time you replace the cap. When it reads “00,” the inhaler is empty. Discard it at that point. Keep an eye on the counter so you’re not caught without medication, and don’t try to pry the device open or force extra doses out of it.
Storage and Expiration
When you first get the Twisthaler, it comes sealed in a foil pouch. Once you open that pouch, the inhaler is good for 45 days, regardless of how many doses remain. Write the discard date on the inhaler label so you don’t forget. Whichever comes first, the 45-day mark or the counter hitting “00,” that’s when you throw it away.
Store the inhaler in a dry place at room temperature. Keep the cap on when you’re not using it. Because this is a dry powder formulation, humidity is its enemy. Don’t store it in the bathroom, and never wash or rinse any part of the device with water. If the mouthpiece needs cleaning, wipe it with a dry cloth.
What to Do If You Miss a Dose
If you forget a dose, take it as soon as you remember. But if it’s already close to the time for your next scheduled dose, skip the missed one entirely and resume your normal schedule. Never double up to make up for a forgotten dose.
Common Mistakes to Avoid
The most frequent errors with the Twisthaler come down to a few habits. Exhaling into the mouthpiece introduces moisture that degrades the powder. Opening and closing the cap without inhaling wastes doses and throws off the counter. Breathing in too slowly fails to pull enough powder into the lungs, which is the single biggest reason dry powder inhalers underperform. If you feel like the inhaler isn’t working, check your inhalation speed first. You should be breathing in as hard and fast as you can, not gently.
Another common issue is holding the inhaler upside down or at an angle when removing the cap. The dose loads by gravity, so keeping the base at the bottom during the twist-and-open step ensures the full dose drops into the chamber correctly. Once the dose is loaded and you bring the mouthpiece to your lips, rotating to horizontal is fine.