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Counting doses...what's the big deal?
That seems to be the usual response we received when discussing mdi dose counting with both physicians and pharmacists alike. Please note that we did not conduct a professional, controlled survey of physicians or pharmacists, but we feel it is a representative sample of most general practitioners and retail pharmacists (we did not talk to any lung specialists). In general, neither were even aware that there was a problem with counting doses. Most thought that some means of dose counting was provided with the medication. After some thought, the typical response was that the patient simply needs to add up the total dosage for a day & divide the number into the total doses of the medication. Then, using that number, use a calendar to determine the day of the last dose & record it on the medication label. When we asked, they all admitted that they never talked about this procedure to the patient! We pointed out that this procedure doesn't account for several factors, such as missed doses, extra doses, or the exact number of remaining doses on the expiration day. We also pointed out that the concept is worthless on any medication taken on an "as needed" basis.
The statistics really don't get any better when you consider the average patient either. In study after study, researchers found that more than 50% of all patients don't keep up with their doses. Most relied on "hearing" the medication when actuating, or shaking the canister to determine if any medication remained. In one study, 54% of patients surveyed were even unaware of the maximum number of actuations listed by the manufacturer for the inhaler they were using, and only 8% reported counting the number of actuations used. In that same study (see link below), only 15% of healthcare providers and 17% of asthma patients could describe how to estimate the amount of medicine left in the canister.
SO WHAT'S THE BIG DEAL....IT'S YOUR BREATH !
Imagine having an asthma attack and you reach for your rescue inhaler only to find that it's empty! Or maybe it's not empty, but in reality all your inhaling is the remaining propellant in the canister. If your not counting the doses, have you ever noticed that sometimes it seems your not getting the relief you should?
WHAT'S THE ANSWER?
In a nutshell, it's education. Healthcare professionals need to know, understand and offer solutions for dose counting to their patients. Patients need to know, understand and solve their dose counting needs. If you don't use Counterstrips, that's fine, but by all means establish a good sound means of dose counting. Treat it as though your next breath depends on it!
If you want to read more on dose counting, we recommend you start with an article in "Chest", a journal of the American College of Chest Physicians.
A direct link to that article is: www.chestjournal.org/cgi/content/full/126/4/1134
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