EDITORIAL
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I have asthma. It really is no big deal these days, so little that the albuterol inhaler I carry often gets clogged from nonuse.
I use a non-CFC-propelled inhaler that tends to get clogged more often than the CFC-propelled ones did. I forget that fact, though, so one dose often gets wasted in the clog and then another after I rinse it out.
To make a long story short, I tend to lose track of how many doses I have used and how many I have wasted and how many could possibly be left. Figuring out when to refill is way too much math for a former English major.
Why am I recounting all this personal stuff? I happened to notice a medical journal in the doctor’s office the other day called Chest, and I just had to pick it up. (Turns out it covers cardiopulmonary issues.) The lead story in the October 2004 issue (yes, it had been hanging around a bit) was a study on how patients determined the number of doses left in their pressurized metered-dose inhalers (pMDIs).
Drug manufacturers typically advise patients to keep track of the doses by counting (back to math). Patients, however, typically shake their inhalers and judge the contents by ear.
If the shake test fails, patients have been told (I am not sure by whom) to float their canisters in water. If a canister sinks, puff away. If it floats only slightly above the water, puff and then call the pharmacy for a refill. If it floats with more than half the canister above water, toss it out and pray that you remembered to refill your inhaler.
The Chest authors, Bruce K. Rubin and Lolly Durotoye, however, found that floatation tests can be inaccurate. Counting doses, however laborious, is more reliable.
For those of you who don’t suffer from asthma, this may all sound like nonsense. It is. When asthma patients don’t have symptoms, they don’t reach for their emergency inhalers. They live, play, work, and go on with their lives. But should they play or work a little too hard—and lose track of their doses—their inhalers could be empty just when they need them.
OK, you say—just do the math. But who does? Not me. I tend to look at the date and think—wow, was it really May when I refilled it? Where did the summer go?
I think my albuterol has Advair-envy. My Advair Diskus (containing fluticasone propionate and salmeterol powder) has a counter that keeps me compliant and keeps my neighborhood pharmacy in business. Let me just put it this way—I do not have to guess when I need to refill my Advair. Could counter technology be put to use for aerosols, cost-effectively?
The October 2004 issue of Chest says it much more scientifically than I can. “If patients are not taught to recognize when a pMDI is empty, they may continue to use the medication canister long past its intended duration of use. Until effective dose counters are added to pMDI inhalers, counting the number of doses administered is the only accurate method with which to tell when the canister should be discarded.”
And that could be dangerous to our health.
Daphne Allen
Editor
