Allergy & Asthma Network Mothers of Asthmatics (AANMA)


By Nancy Sander

How many puffs are in your or your child’s aerosol metered dose inhaler right now? How do you know? Are you sure?

Knowing the right answer is a matter of life and death. Unless you track each spray manually or the inhaler has a built-in dose counter/ indicator, you could come up breathless in time of need.

Drug manufacturers fill each inhaler canister with a specific number of medicine doses. Remove your inhaler canister from the plastic “boot” and the label should tell you how many doses are inside. If it says 200, for example, that means only the first 200 sprays will contain the right amount of medication — all that’s left after that point is propellant and diminishing doses of medication.

This is a particular concern for bronchodilators, the fast-acting medications used at the first sign of asthma symptoms, before exercise to prevent symptoms, and/or during a full-blown asthma attack. Bronchodilator inhalers are not scheduled for routine, daily use.

In 2004, Allergy & Asthma Network Mothers of Asthmatics (AANMA) asked the U.S. Food and Drug Administration (FDA) to provide guidance to the pharmaceutical industry on developing dose counters or indicators for inhalers. After all, there’s no other medication where the user doesn’t know when there is no medication left!

FDA agreed and published guidance calling for newly developed inhalers to have dose counters. Only one aerosol metered-dose bronchodilator inhaler has a dose counter so far, but other manufacturers say dose counters are coming for their products.

If your inhaler doesn’t have a dose counter, take a tip from one of AANMA’s Facebook friends, Beth Trautman Atkerson, who puts sticky note tape on her son’s inhaler and adds a tally mark each time the inhaler is used. She says this also helps in tracking her son’s usage: “If he is having a rough day, I use a different color pen to mark each use and can accurately report his dosing needs to his doctor.” Even so, she adds, “our fail-safe is to ALWAYS carry a backup!”

However you keep track of doses that have been used, just be sure you count every discharge of your bronchodilator inhaler. For your child, monitor closely the number of inhaler puffs expended away from home at school, during after-school activities, etc. That includes any sprays released into the air necessary to prime the inhaler when it is used the first time, if it is dropped, or when more than a few weeks have passed since it has been used. Depending on the inhaler, priming requires two to four sprays.

Reviewed by Michael Mellon, MD and Martha Hogan, MD