<p>Ciclesonide is for inhalation use only. The recommended starting dose of Ciclesonide is 160 micrograms once daily which is usually also the maximum dose. Dose reduction to 80 micrograms once daily may be an effective maintenance dose for some patients. Ciclesonide should preferably be administered in the evening although morning dosing of Ciclesonide has also been shown to be effective. There is no need to adjust the dose in elderly patients or those with hepatic or renal impairment. Patients with severe asthma are at risk of acute attacks and should have regular assessments of their asthma control including pulmonary function tests. Increasing use of short-acting bronchodilators to relieve asthma symptoms indicates deterioration of asthma control. If patients find that short-acting relief bronchodilator treatment becomes less effective, or they need more inhalations than usual, medical attention must be sought. In this situation, patients should be reassessed and consideration given to the need for increased anti-inflammatory treatment therapy (e.g. higher doses of Ciclesonide or a course of oral corticosteroids). Severe asthma exacerbations should be managed in the usual way.</p>

<p>&nbsp;</p>

<p><strong>Administration</strong></p>

<p>Before using your inhaler for the first time, or if it has not been used for a week or more, &quot;test fire&quot; it, i.e. release one puff into the air.<br />
<br />
<strong>How to use your inhaler correctly</strong>:</p>

<ul>
	<li>Remove the mouthpiece cover, and check the mouthpiece thoroughly to see that it is clean. Shake the inhaler vigorously.</li>
	<li>Hold the inhaler as shown between index finger and thumb. Breathe out gently through your mouth and immediately place the mouthpiece in your mouth between your teeth (Do not bite it).</li>
	<li>Grip the mouthpiece firmly with your lips. Tilt your head slightly backwards. Start breathing in slowly through your mouth. At the same time press the canister as shown, to release one dose while continuing to breathe in steadily and deeply.</li>
	<li>Remove the inhaler from your mouth. Hold the breath at least for 10 seconds, or as long as it is comfortable. Breathe out slowly.</li>
	<li>If another dose is required, wait for at least 1 minute and repeat the whole process. After use, place the cover to close the mouthpiece.</li>
	<li>Shake well before each use.</li>
</ul>

<p><strong>How to clean your inhaler</strong>:</p>

<ul>
	<li>Gently pull the metal canister out of the plastic body of the inhaler, remove the mouthpiece cover.</li>
	<li>Rinse the plastic body and the mouthpiece cover in warm water but do not put the metal canister into water.</li>
	<li>Leave to dry in warm place, avoid excessive heat.</li>
	<li>Replace the canister and the mouthpiece cover correctly.</li>
	<li>Clean your inhaler at least once a week.</li>
</ul>