Responding to Research: Dose Counters

I might have burst out laughing at my computer when I read this headline in my Google Alert: “Do Dose Counters Matter In Asthma Inhalers’ Effectiveness?”

I laughed because from a patient’s perspective, duh this is a good idea. Except I also laughed because hahaha I had to go to the pharmacy earlier this week because my Zenhale (Dulera) inhaler WITH THE COUNTER was empty. And because, no obviously my inhaler is equally effective if it has a counter or not, the difference is ME looking at the counter.

(Yes, this is the type of stuff that amuses me.)

And HEY, guess what? The research agrees with me.

The research is focused on the addition of a counter on a rescue inhaler (albuterol) correlating with fewer emergency department visits.1 So whereas I throw out inhalers that I think are possibly maybe close to empty, or use inhalers that are already empty, people can actually LOOK AT THEIR RESCUE INHALER and see if it has medicine. What a concept.

Except here’s the thing:

You have to look at the counter.

I know this is not incredibly difficult to do, but guess what? When only one of your four inhalers has this magical device, the novelty wears off quick. I should attempt to make a point to look at the dose counter on my Zenhale each morning when I am waiting(-ish) between puffs. Even if I did it twice a week, it would probably greatly improve my ability to get a new inhaler before that one is empty.

As with all things, here it is:

I am the reason my treatment has the chance to be effective—by actually using the inhaler as prescribed.

I do the actual work involved in getting medicine into my lungs. In itself, a dose counter does not make my inhaler more effective. And until all of my inhalers are equipped with the lovely little analog invention known as the dose counter—which is pretty darn similar to the rubber date stamp that only goes up to 2007 I have in my basement—I’m probably not going to integrate this data into my life very well.

Because let’s be honest, the Oh look, the counter says I am out of Zenhale, wonder how many days that’s been like that? situation says to me that If I can’t seem to work into my life/brain that the inhaler I take a very predictable 3 puffs a day of (on some occasions 4 puffs, but technicalities) will last me about 40 days, how am I actually going to remember to, you know, check a counter?

If all of my inhalers had one? There’d be a much, much higher chance that this would become habit. But when my Zenhale has one and my Canadian Qvar, Atrovent, and Ventolin don’t? Well, I’m really getting 1/4 of the information that I need—and that’s just not enough. The study in question adjusted for this outcome by enrolling participants who already used inhalers with counters vs. the non-counter control, otherwise I’d question the novelty factor1. However, I wonder—what if the exacerbation leading to the emergency department visit was caused by a different inhaler being empty—one that was not the rescue inhaler?

The novelty of being able to see how full your inhaler is becomes just that: a novelty. Novelty wears off. A dose counter in itself is not going to make things any better if I don’t look at it. But, counters being standard might help—sort of like knowing when to buy more cereal, or how your car has a fuel gauge. I mean, they don’t expect us to know by manually tracking if we’ve got enough gas left in the car—why is an inhaler any different?

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