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Do Dose Counters Matter in Asthma Inhalers' Effectiveness?

Metered dose inhalers with a dose counter integrated could reduce the number of visits to emergency departments.

Metered dose inhalers (MDIs) with a dose counter integrated could reduce the number of visits to emergency departments (EDs) according to a recent study. The study was conducted by David Price, MB, B.Chir, MA, DRCOG, FRCGP, of Academic Primary Care a the Institute of Applied Sciences at the University of Aberdeen in the UK, and colleagues, and was published in the Journal of Asthma and Allergy.

The authors say, “We hypothesized that the dose information provided by an integrated dose counter could lead to a reduction in the number of respiratory-related ED visits by decreasing the use of empty or near-empty canisters.” In order to find out whether or not their hypothesis was correct, they examined the records of 93,980 patients, who had prescriptions for albuterol inhalers. Of the total number of participants, 72% had an inhaler with a dose counter, and were considered the dose counter cohort.

The primary end point for the study was the incidence of respiratory-related ED-visits. “Secondary end points for patients with asthma were the incidence rate of severe exacerbations and rate of acute respiratory events,” say the researchers.

Out of the total of 93,980 patients in the study, 75,787 were diagnosed with asthma, including 80% of the dose-counter cohort and 82% of the non-dose-counter cohort. “Those [patients with diagnosed asthma] in the dose counter cohort had 51% lower incidence of respiratory-related ED visits,” report the researchers.

The use of a dose counter device was not associated with various indicators of disease control. The researchers say, “Our data suggest that dose counters may enable patients to directly know when their rescue medication is empty and thus avoid using empty inhalers during exacerbations.” For patients with more severe disease, lowering the number of costly ED visits could substantially lower the overall cost of care.

The authors note that there are some limitations to this study, including the fact that it is an observational study and therefore treatment assignment was not random. Additionally, the researchers did not have detailed patient data available. They suggest future studies should be completed to find out if integrated dose counters impact other patient populations.

“We found that the integration of dose counters into rescue inhaler devices is associated with decreased ED visit frequency,” conclude the researchers, adding, “The integration of dose counters on rescue MDIs could represent a simple and effective tool to improve clinical outcomes during exacerbations, with a potential for cost savings to health care systems.”

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