The dosage should be adapted to the individual requirements. The following dosages are recommended for adults and children > 6 years: Acute asthma episodes: 21 mcg ipratropium bromide + 50 mcg fenoterol hydrobromide: 2 actuations are sufficient for prompt symptom relief in many cases. In more severe cases, if breathing has not noticeably improved after 5 minutes, two further actuations may be taken.
If an attack has not been relieved by 4 actuations, further actuations may be required.
In these cases, patients should be advised to consult the doctor or the nearest hospital immediately.
Intermittent and long-term treatment (in asthma BERODUAL metered dose aerosol should be used only on an as-needed basis): 1 - 2 actuations for each administration, up to a maximum of 8 actuations per day (average 1 - 2 actuations 3 times daily).
In children BERODUAL metered dose aerosol should only be used on medical advice and under the supervision of an adult.
Patients should be instructed on the correct administration of the metered dose aerosol to ensure successful therapy (see Instructions for use as follows).
Instruction for use: Before first time use of the metered dose aerosol, the following rules should be observed: Remove protective cap and depress the valve twice.
Before each use of the metered dose aerosol, the following rules should be observed: 1. Remove protective cap.
(If the inhaler has not been used for more than three days the valve has to be actuated once).
2. Breathe out deeply.
3. Hold the inhaler and close lips around the mouthpiece.
The arrow and the base of the container should be pointing upwards.
4. Breathe in as deeply as possible, pressing the base of the canister firmly at the same time, this releases one metered dose. Hold the breath for a few seconds, then remove the mouthpiece from the mouth and breathe out. The same action should be repeated for a second inhalation.
5. Replace the protective cap after use.
The container is not transparent. It is therefore not possible to see when it is empty. The inhaler will deliver 200* puffs. When the labelled number of doses have been used the canister may still appear to contain a small amount of fluid. The inhaler should, however, be replaced because the patient may not get the right amount of medicine in each actuation.
Clean the mouthpiece at least once a week.
It is important to keep the mouthpiece of the inhaler clean to ensure that medicine does not build up and block the spray.
For cleaning, first take off the dust cap and remove the canister from the mouthpiece. Rinse warm water through the mouthpiece until no medication build-up and/or dirt is visible.
After cleaning shake out the mouthpiece and let it air-dry without using any heating system. Once the mouthpiece is dry, replace the canister and the dust cap.
*300 [when the inhaler delivers 300 puffs]