This is one of my favorite (not!) answers when I ask one of my patients why they come to class wheezing and can barely breathe. I have to pause before I figure out how to tactfully ask the question: You know you need your inhalers, so how could you not know you were running low?
And then the REAL question: if this person refills their inhaler regularly, every month, how come it’s empty?
Have you been using your inhalers ‘on demand’ more often than usual?
This happens to many patients. You go along fine, 4 times a day 2 puffs, then it changes again. Or you get a mild cold. Or something stressful happens. Before you know it your inhaler will be empty and you will have 5 days left before you can get a new inhaler.
Everyone takes extra ‘rescue’ puffs from time to time. But it’s important to keep track of how many of these extra puffs you take each day, and why.
Some inhalers come with a built-in counter to let you know when you’re approaching the bottom of the canister. Even with a counter, it’s a good idea to make sure you have enough medication so it’s there when you need it most. Make it a habit to look at your counter on the 15th of the month. If you’ve used more than half of your doses, it’s time to talk to your doctor.
Still, some insurance policies will only pay for one inhaler per month. What can you do in this situation? Many people will pay the cash price to have another rescue inhaler on hand. Your doctor should have no problem prescribing you for this.
In asthma we divide the diagnosis into ‘controlled’, ‘poorly controlled’ and ‘uncontrolled’. Controlled means that the drugs are doing their job and the patient has very few exacerbations or short breathing attacks.
“Poorly controlled” means that the patient has many episodes or exacerbations that often send him to the hospital. “Uncontrolled” means that nothing we prescribe is working, or that the patient is not complying with the medications and inhalers we prescribe.
This also applies to COPD. I had a patient who took a puff from his inhaler every hour. That is not a symptom control strategy!
If you find that the inhaler regimen you’ve been prescribed just isn’t covering you and keeping you symptom-free, it’s time for a medication review with your doctor.
What to do when your inhalers are all empty – and it’s only the 25th of the month
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