What is The Importance of Understanding When an Inhaler is Empty?

Both pressured metered dose inhalers (pMDIs) and Dry Power Inhalers (DPIs) can have dose counters to indicate the number of doses left in an inhaler.¹ Professor Will Carroll talks about the methods to track doses remaining for inhalers without a dose counter and practical tips to help patients.

In 2018, 12% of adults with respiratory conditions in hospital were found to be using / relying on empty reliever pMDIs.² More recent research has similarly indicated that also almost a third of patients studied were using their inhaler beyond the designated zero.¹

Using inhalers beyond the designated zero may cause ineffective dosing of medication leading to uncontrolled respiratory conditions. It is important that patients understand when their inhaler is empty to ensure disease stability.

Professor Carroll also discusses some misconceptions from patients like “there is medicine available in a pMDI if the inhaler continues to contain spray”, and why you need to shake some inhalers before use. He also presents on the floating method and use of dose charts in estimating how much is left within an inhaler.

Please also consider watching ‘What are the Hidden Risks Associated with Incorrect Inhaler Usage?’ by Professor Anna Murphy where she presents her own research which aimed to explore the extent to which an inhaler is used and disposed of by patients.

References

1. Asthma & Lung UK. Common concerns about asthma medicines. https://www.asthmaandlung.org.uk/conditions/asthma/treatments/concerns

2. Tsangarides A, Wilkinson A, Mir FP169 Disadvantages of salbutamol pressurised metered-dose inhalers (pMDIs) Thorax 2018;73:A193-A194.

3. Murphy AC, Carroll W, Gotsell M, et al. BMJ Open Respir Res 2024;11:e002579.

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• Professor Will Carroll

  Clinical and Academic Lead in Paediatric Respiratory Medicine

  Read biography
  Professor Will Carroll

  Clinical and Academic Lead in Paediatric Respiratory Medicine University Hospitals of the North Midlands

  Role and Location
  Will is an Honorary Reader in Child Health at Keele University and a Consultant Paediatrician at the Staffordshire Children’s Hospital at Royal Stoke. He is currently the RCPCH Assistant Officer for Examinations, the Deputy Clinical Tutor for the University Hospitals of North Midlands, the Chief Editor of Paediatrics and Child Health and the co-editor of the widely used ‘Sunflower book’ with Tom Lissauer.

  Education
  – BA (Physiological Sciences)
  – BM BCh (Green College, Oxford)
  – MD

  Research Interests
  Faux-Nightingale A et al, Symptom patterns and life with post-acute COVID-19 in children aged 8-17 years: a mixed-methods study protocol. 2023. BJCP Open.

  Charles R, Brand RLP, Gilchrist FJ, Wildhaber J, Carroll W. 2022. Why are children with asthma bullied? A risk factor analysis. Arch Dis Child, 612-615, vol. 107 (6).

  Gilchrist F and Carroll WD. 2021. Chapter 17: Respiratory Disorders. In Illustrated Textbook of Paediatrics. Elsevier.

  Gilchrist FJ and Carroll WD. 2021. Managing chronic wet cough on children: another piece of the puzzle. Lancet Respir Med, 1078-1079. Vol. 9(10)

  Swift JA, Carroll WD, Gilchrist FJ. 2021. Single-centre survey of parents regarding the hidden burden of paediatric flexible bronchoscopy. BMJ Paediatrics Open, 1-2, vol.5 (1)

  Memberships
  Royal College of Paediatric and Child Health (RCPCH)