# A nurse teaches a client using a tiotropium HandiHaler. Which instruction is most important?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391778&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A nurse teaches a client using a tiotropium HandiHaler. Which instruction is most important?

## Option

1. Use this inhaler twice daily, once in the morning and once at bedtime, for COPD control
2. Swallow the capsule whole with water once daily to prevent COPD exacerbations
3. Inhale the powder once daily; do not swallow the capsule and rinse the mouth afterward **✔ Correct answer**
4. Dissolve the capsule contents in 5 mL of normal saline and administer via nebulizer twice daily

**Correct answer: 3**

## Explanation

Correct (2): Tiotropium HandiHaler capsules are inhaled only, never swallowed. Place the capsule in the device, pierce it, then inhale forcefully (forceful for DPI, unlike MDI). Once-daily controller dosing. Rinse mouth to reduce anticholinergic dry mouth. (1) Not BID/PRN. (3,4) Capsules are for inhalation, not oral.

## In-depth explanation

Memory Tip Tiotropium = "Once-daily, Inhale-only, Anti-Spit (dry mouth)." DPI requires FORCEFUL inhalation; MDI requires SLOW deep inhalation. Caution Use spacer with MDI, not with DPI.

## Clinical scenario

Scenario 70-year-old female with COPD newly prescribed tiotropium 18 mcg via HandiHaler once daily. First-time teaching with DPI device.

## Key concepts

- **Long-acting muscarinic antagonist (LAMA)** — Tiotropium, umeclidinium, aclidinium, glycopyrronium; daily COPD bronchodilator.
- **HandiHaler device** — Single-capsule DPI requiring forceful inhalation; capsule is pierced before use.
- **DPI vs MDI technique** — DPI: forceful fast inhalation. MDI: slow deep inhalation. Spacer used with MDI only.

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