The following observations relevant to systemic absorption were made in clinical studies. In one uncontrolled study a statistically significant decrease in responsiveness to metyrapone was noted in 15 adult steroid-independent patients treated with mg of flunisolide per day (the maximum recommended dose) for 3 months. A small but statistically significant drop in eosinophils from % to % of total circulating leucocytes was noted in another study in children who were not taking oral corticosteroids simultaneously. A 5% incidence of menstrual disturbances was reported during open studies, in which there were no control groups for comparison.
1. To remove the mouthpiece cover, hold between the thumb and forefinger, squeeze gently and pull apart as shown. Check inside and outside to make sure that the mouthpiece is clean, and that there are no foreign objects.
Testing Your Inhaler: If the inhaler is new or if it has not been used for three days or more, one puff should be released into the air to make sure that it works.
2. Hold the inhaler upright as shown, with your thumb on the base, below the mouthpiece. Breathe out as far as is comfortable.
3. Place the mouthpiece in your mouth between your teeth and close your lips around it but do not bite it.
4. Just after starting to breathe in through your mouth press down on the top of the inhaler to release a puff while still breathing in steadily and deeply
5. Hold your breath; take the inhaler from your mouth and your finger from the top of the inhaler.
Continue holding your breath for a few seconds or as long as is comfortable. Breathe out slowly.
6. If you are to take another puff, keep the inhaler upright and wait about half a minute before repeating steps 2 to 5.
7. After use always replace the mouthpiece cover to keep out dust and fluff. Replace firmly and snap into position.