Can Someone PLEASE Just Put a Darn Dose Counter on ALL of My Inhalers?

At 12:10 am, I send the following text to Dia:

"Omg I’ve had a cough/super mild shortness of breath for like...2.5 days...

Guess who just realized her Qvar sounded like it was just slowly shooting out propellant? 🙋🏻‍♀️

A classic combo it always takes too long to notice."

This. Is. How. It. Always. Goes.

I have a weird mini-flare. I cannot figure out for the life of me what is causing it: the coughing, the very mild shortness of breath that is more annoying than anything. And then, days later, I discover: how many days exactly have I been inhaling propellant rather than inhaled steroid?

Tracing my symptoms back

In retrospect, each time this happens, I try to figure out perhaps how long it has been before I discover my Qvar is dead and that I started getting incrementally worse. Given Qvar is my add-on steroid, I am not totally without when I lose potency (or the medicine altogether) at the end of a canister.

I noticed the sound of the spray with my Saturday midnight dose.

On Tuesday, I am phone banking, and a nurse I am speaking with tells me to take care of my throat. I just tell her “Oh, I always sound like this.”

It is not quite true, but it is true enough. I have had a slight asthma and/or inhaler-induced rasp for years. But, did my cough make it worse?

On Monday I felt that my lungs were pretty good. Then I worked out for an hour. So, I might have brushed off some weirdness on that, too.

Thursday night, I went out door knocking with our pre-election canvassing team. It was in the low minus single digits in Celsius, but I also figured that would be a prime scenario to trigger the low-level breathlessness I experienced Friday.

The question now was, was it actually one of these things, or was it the Qvar, or was it a combination?

Why don't all asthma inhalers have a dose counter?

I find it interesting that currently 2 of my inhalers have counters, and 2 do not. My Zenhale has a very readable counter; my Spiriva Respimat has a less readable counter but the added bonus is that it locks after 60 actuations and whatever the required number of prime sprays is (I just prime it til it looks and sounds right).

That leaves my Ventolin and my Qvar without counters. Ventolin lacking this is probably more of a big deal to many people, but for me, it is actually less of a big deal because I often misplace them or they expire before I finish them. I probably technically go through a few Ventolins a year in terms of actual puffs, but look I am still taking the occasional hit off of inhalers I got in 2020 over here for milder symptoms and they seem fine... though I’ve stopped using those recently realizing that’s uhh 3 years ago, and they have just become unearthed from somewhere. But of course, being me, I have to experiment right? As long as the Ventolin I carry on me away from home is within the proper date, I am willing to experiment a bit.

The Qvar is what gets me though, and I would love for it to lock as the Spiriva does because I cannot tell right away when my Qvar is not working. It takes days for that low-level inflammation to work back up, and then I have to get it back down!

For me, this is absolutely a design problem. It is 2023. It is completely possible to make my inhaler just a tiny bit smarter, and for whatever reason the manufacturers choose not to. Not to mention both of these drugs are brand names and one (Qvar) is still on patent so I am guessing we will get a counter whenever their patent is about to expire... so they can re-patent the whole thing again.

Counting doses in other ways

I have tried other tracking methods. Manually entering into apps. Propeller, which does not seem to have this basic dose-counting feature baked in in an easy way--or, which offloads from my phone for whatever reason rendering itself useless. I have also considered just keeping a sharpie with my Qvar and drawing dots like tallies but this seems to be a questionable method.

The other ways are unreliable and prone to my own errors--shoutout to my ADHD for making this even harder than it would otherwise be! Do you know what is reliable?

A DOSE COUNTER.

And yet still, in 2023, here I am, complaining that this very, very analog technology has still not been added to two of my inhalers when the other two track themselves perfectly fine. At least my compounded cream has a little window on it so I can see how much is left! What about a little inhaler window?! (...Logistics, I know. That's why they should just put a freaking counter on here.)

So, this becomes a "me problem" I guess. And my solution to that? Well, Dia, I will text you again with the same message in about two months, as it is known to happen!

How do you keep track of the doses in your inhalers without counters on them?