Every year millions of doses of asthma medication go to waste. Some are lost and others outdated, but one factor which could easiliy be improved would be to add a dose counter to every canister of medication. Why this is not already done is mind-boggling.
Fortunately, a few of our current inhalers do come with a built in dose counter.
Of the albuterol HFA inhalers, only Ventolin and Ventolin ReliOn feature these counters on the backside of the plastic device. However, even if your inhaler does not feature a counter, you can keep track by the hash mark method (see below). Every inhaler lists how many doses are in the canister to start. Remove the canister from the device, find the total doses, and write this number on the outside, if it isn’t already there. Then every time you use the inhaler, but a small hash mark on the outside. When you’ve made the appropriate number of hash marks, you can count on the canister being empty.
A typical albuterol canister has 200 inhalations, plus a few extras to prime the unit. Two hundred inhalations would generally only be 100 doses, however, as most asthmatics take two inhalations per usage. The Maxair Autohaler contains 400 inhalations. Ventolin ReliOn contains 60 active inhalations. Make sure you check your own particular medicine so you know how much you’re starting with.
Floating an empty canister in water is not an accurate way to assess how much medication remains. With any of these inhalers, they may not feel completely empty after using the full number of dosages, but the device may no longer deliver the appropriately metered amount, so don’t keep using a device that should be empty.
The other popular inhalers with counters are the Diskus device (Advair and Serevent Diskus) and some of the other steroid inhaler medications. Since these are meant to be used on a daily basis, each inhaler contains one month of therapy when used properly. This is a handy way of judging whether you are indeed taking your medication as prescribed. A device with 60 inhalations to be used twice daily should be emptied with a month of regular use. If you find the inhaler is lasting you longer, you are skipping doses, and your asthma may not be under sufficient control.
Asthmatics who use a nebulizer solution have an easy way of knowing how much medication remains: simply look at the bottle. Nebulizer solutions also come in single-dose vials, which of course are easily counted.
From speaking with thousands of asthma patients over the years, I’d say at least 10% of inhaled doses are lost one way or the other. On a medication that costs over $150 a month (Advair, for example) this amounts to $180 a year down the drain. Those who are not paying for their medications may not care, but people who are will want to pay careful attention to their dose counters, or keep track manually. Patients taking multiple medications for asthma or COPD have even greater potential savings.