Allercy and Asthma Health
The Official Publication of AAN - MA

Keeping Count of Your Inhaler Doses

by Rhonda Vosmus, RRT, NPS, AE-C


 “What do you mean my inhaler is empty? Look at the mist come out when I spray it!” We hear this countless times from our patients and families who think because you see the spray, it is medication being emitted. In fact, a metered dose inhaler will spray some 50 times after the medication is gone.

A study about inhaler dose counters was published in Medscape Medical News and presented at the November 2013 American College of Allergy, Asthma Immunology (ACAAI) Annual Scientific Meeting by researcher Anne Rigazio.1 Dose counters on quick-relief inhalers cut respiratory-related emergency department (ED) visits by almost half, according to this study of almost 94,000 patients. This research also found that after one year of albuterol use, the annual rate of ED visits was significantly reduced for patients who use dose counters. When split according to diagnosis, the risk reduction associated with dose counters was evident for exercised-induced bronchospasm (83%) and chronic obstructive pulmonary disease (COPD) (60%), but it remained significant for asthma (51%).

There are approximately 35 different inhalers of quick relief and controller medications available to patients in the United States. Each device and medication has a slightly different priming instruction, application, and dose count. For example, an institutional sized dose of quick relief contains 60 doses of medication and the dose counter starts with 64 – the first four are to be priming doses. A retail pharmacy has quick-relief canisters that contain 200 doses of medication with the counter (if it has one) reading 204 when dispensed. All of this can be confusing when someone may have inhalers stored in different places: desk, backpack, purse, cupboards with school nurses, nightstands, etc.  Each device may also have slightly different re-priming instructions as well.

In Anne Rigazio’s study, she speculated that dose counters on inhalers may drive patients to oral corticosteroid use sooner and have fewer ED visits. Health care providers hope that with proper prescribing, enhanced self-management education on using inhalers (such as picture guides of how to use the inhalers), written asthma plans, and access to primary care, that patients can minimize ED visits and eliminate the need for oral corticosteroids altogether. 

More than 24 million Americans have asthma. An estimated 15 million Americans have COPD. Some 24 million people have evidence of impaired lung function.2 Direct health care costs to manage these chronic diseases are staggering. Keeping count of how many doses are in inhalers – to know when they are empty – is essential to improving quality of life and decreasing health care costs by reducing hospital visits. There is also value added to knowing the remaining doses in inhalers: most of these devices are based on monthly refills. Your clinician should always ask about your refill practices to better understand your level of asthma and COPD control.  They may also contact your dispensing pharmacy for refill data to determine adherence practices, and in some cases, better understand why a your condition may not be improved or well controlled.

As an Asthma COPD Resource Specialist working in primary care, I remind patients that we all share the same goal: we want the least amount of medication with no symptoms and no side effects to control the lung condition. A picture speaks a thousand words; pictorial guides are extremely helpful handout tools, so ask for these things if you feel the need.

Your demonstration of how you use your devices is another key to helping your clinician help you. Bring your inhaler devices to every doctor’s office visit. Your health care provider may also have devices to help demonstrate proper device usage and keeping your devices clean, as well as point out the value of “keeping count” of your inhaler doses. •

Rhonda Vosmus, RRT, NPS, AE-C is an Asthma-COPD Resource Specialist working in primary care in Portland, Maine.  She is also a Leadership Board Member of the American Lung Association of Maine, serves on the board of the Maine Society of Respiratory Care, and is a member of the AARC.   


  1.  American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting: Abstract 11, presented November 10, 2013
  2. Asthma and COPD Prevalence (CDC Report 2011 data)


Top of Page Back