Aerosol Guide - AARC.org

doses may be impractical and undependable, especially in patients who use reliever medications
on the go.
Therefore, the U.S. Department of Health and Human Services FDA requires new pMDIs
to have integrated dose counters and recommends that all pMDIs have dose counting
devices that indicate when the pMDI is approaching its last dose. 61 The dose counter is a
counting device attached to the top of the pMDI canister or to the boot of the device.
When the pMDI is actuated, it counts down the number of actuations from the total
remaining in the canister. The Ventolin ® HFA (GlaxoSmithKline, Research Triangle Park,
NC) and Flovent ® HFA (GlaxoSmithKline) have built-in dose counters (Figure 19).
Figure 19. Counter on Ventolin ® HFA and Flovent ® HFA pMDIs
Also, mechanical or electronic dose counters have been available from third parties for use
by attachment to a range of pMDIs. Although research has confirmed acceptable performance
and patient satisfaction by pMDIs with dose counters, 62-64 care must be taken to assure
that a third-party dose counter works with the specific pMDI being used. 18,65 Some of the
built-in counters may not fit the spacer, and improper fit to the canister may interfere with
proper actuation, resulting in no or partial drug being emitted and in a miscount of remaining
doses. 65 Using a third-party dose-counting device increases the cost of aerosol therapy,
which may limit their wide acceptance. Figure 20 shows currently available pMDI dose
counters in the United States.
Figure 20. Currently available pMDI dose counters on the market
With any third-party counter, read the product label and accompanying package information
for each pMDI before use and follow the manufacturer's recommended doses. When
attempting to keep track of the number of puffs remaining in the pMDI, the following steps
should be taken:
32 American Association for Respiratory Care A Guide to Aerosol Delivery Devices for Respiratory Therapists, 3rd Edition © 2013