The Empty Inhaler Strikes Again

I take four inhalers, and only one of them actually has a dose counter on it—and after all, research and experience indicate this may not even help much. What’s ridiculous about inhalers compared to, oh, just about any other medicine out there, is that you cannot visually check how much is left. This leaves us to our own devices: manually trying to track, or using digital tools to track. For me, since I often get a few months of inhalers at a time, even the dispensing date isn’t always accurate. Case in point, the Qvar inhaler I was using in July 2017 left my pharmacy December 22, 2016. Zero clue when I started to use it! I used to be smart and write the date I started the inhaler on the canister. Sure, this wasn’t terribly accurate either, also, I didn’t always read it, but at least I had a general idea of when its lifespan would be up if I needed that enlightenment.

Such enlightenment would have been helpful down the road, past self. And not the spiritual kind. Because when it comes to Qvar, it takes awhile to tell I’m not getting the medicine—and because asthma, it’s not always that obvious. And by the time I figure out that it’s an empty-inhaler-related-problem, my lungs feel not good and the Propeller app is freaking out on me.

Keeping track

Since somewhere around April 25, I’ve been using the Propeller Health system. I don’t recall ever shifting my sensor to a new Qvar prior to today, so, I’m guessing that my current Qvar has been in existence since at least the last week of April. With 200 doses in a canister and using, on average, 2-3 puffs per day that gives me 66(.66) to 100 days of use—we’ll split that down the middle, although I use 3 most days so this is an overestimation, but we’ll go with a lowball of 83 days per inhaler. (I’m not good at math so just deal with me here okay?) July 22 would be approximately 88 days into this inhaler, if I started a new one around the time I began using Propeller, which seems reasonable. You may see a discrepancy here. If I can use a Qvar for about 83 days max and I am at 88, well, we have a bit of a problem.

Correlating the data—both quantitative and qualitative

On about Wednesday I noticed a perceptible change in my breathing, but not too bad. After all, there are forest fires in BC and it’s summer and possibly humid and there are reasons. This would be approximately Qvar Day 85. Nothing a little Ventolin couldn’t handle. Qvar Day 86 - 8 puffs of Ventolin. Decided to try and more actively treat this as yellow zoning—bumped up my Zenhale and Qvar and took Ventolin regularly. Propeller tells me my asthma is not well controlled. Qvar Day 87 - 9 puffs of Ventolin. Qvar Day 88 - 2 puffs of Ventolin. Pull out the nebulizer mid-afternoon. Propeller freaks and informs me that my asthma is very poorly controlled and to please contact my doctor. I reply sassily in my head to the app that I’ve climbed over worse and it’s Saturday and maybe I’ll call Dr. Smartypants on Monday if things aren’t better. AND THEN...

And then I swear a little in my head as I swap out my Zenhale which has just clicked over to zero for a fresh one, and consider is my Qvar empty? I popped off the Propeller sensor, and the canister felt quite light and sounded rather swooshy. (Things like this are partly why this is not medical advice.) Test spray. It feels kind of laggy and not-fresh (also NOT a scientific method of anything and I could be so wrong, so do not rely on this nonsense).

This has happened before when my Qvar has essentially died. Like now. A low-level, annoying breathlessness that creeps up as I get further from a strong, typical inhaled steroid level, some air trapping, and a cough that occasionally escalates beyond my usual level of cough. The Ventolin works great for a bit but not really long enough.

Well, crud. The empty inhaler strikes again.

Sorting the yellow zone out

I immediately swap out my Qvar for a brand new one, make a note in the Propeller app that my Qvar was likely empty and that I hope this solves things (and helps me know when I swapped out my Qvar last). I try to mentally calculate how long I’ve been on the crud spiral. In my head I question how much to ramp up my Qvar, how much it will help, will it help? It better help, I got things to do.

With a nebulizer fairly recently in my lungs, I take a fresh dose of bumped-up Qvar—now actually giving me meds—and take an extra hit of Zenhale.

And while I suspect it’s the Qvar and I hope it’s the Qvar, I still don’t know for sure. I’ll continue on this path for at least 72 hours and hope for the best.

Reflecting on recent reading about inhaled steroids

As I returned to my laptop to work after all this nonsense, my recent reading of the Severe Asthma Guidelines suddenly found itself in my brain. The part about “controlled severe asthma” which “worsens on tapering of […] high doses of inhaled [corticosteroids] […].”^{1 (68)}

Because that is exactly what happened here. And it’s the middle of summer. And the air quality is fine. And I’m mostly inside. And thank goodness this did not happen in winter.

Now I’m off to find a Sharpie to write today’s date on both of my inhalers/canisters, and hoping that this residual inflammation lifts before I go spend a week out at the cabin in two days. Perhaps I should re-start those nasal steroids while I’m at it...

How do you keep track of when your inhalers are about to run out? Share your ideas in the comments.