Only remove capsules immediately before use.

Pierce capsules once only.

Tilt inhaler so mouth-piece faces slightly downward which allows capsule to drop forward into spinning chamber.

Keep inhaler tilted in this way and breathe out completely away from the inhaler.

With the head tilted upwards, the patient should inhale deeply at an even, steady rate that is fast enough to make the capsule spin - the capsule will make a “rattling” sound in the inhaler when inspiratory flow is sufficient.

The inhalation rate may be slowed down if coughing occurs – controlled coughing should be encouraged where possible.

After the dose from each capsule is inhaled, the patient must breath hold for 5 s – exhale and cough AWAY from the inhaler to prevent humidity build-up within the device.

The 10 capsules should be taken closely together over a 3–5 min.

A sip of water may be taken throughout the challenge to relieve cough and/or dry throat.