Dose Counters Reduce Respiratory-Related ER Visits

Built-in dose counters for rescue inhalers were shown to decrease respiratory-related emergency room visits for asthma patients by 55%, according to research recently presented at the Annual Scientific Meeting of the American College of Asthma, Allergy, and Immunology (ACAAI) in Baltimore.

“Dose counters are being mandated by the FDA, but many products without them are still available,” says Allen Meadows, MD, an ACAAI fellow and chair of the Public Education Committee. Newer inhalers feature integrated dose counters, which show the number of remaining doses left in the rescue inhaler.

Without a dose counter, it can be difficult to determine exactly how much albuterol is left in the inhaler. If a patient doesn’t realize the inhaler is empty and reaches for this life-saving medication in the midst of asthma attack, it could very likely result in a trip to the ER.

Estimates suggest that asthma attacks account for 2 million ER visits in the US each year. Researchers conducted a retrospective, comparative analysis of US claims data to estimate the impact of integrated dose counters for rescue inhalers on respiratory-related ER visits.

They looked at a total of 93,980 patients, ranging from age 4 to 64 with a diagnosis of asthma, exercise-induced bronchospasm, or chronic obstructive pulmonary disease.

All of the patients had received their first prescription of albuterol, with a dose counter or without a dose counter, between January 2010 and September 2011. They all had two years of continuous data on file—one year for baseline and one year for outcome.

The dose-counter cohort included 67,251 patients, compared to 26,729 patients who used a rescue inhaler without a dose counter. The researchers estimated the incidence rate of respiratory-related ER visits in the total population to be 45% lower in the patients using rescue inhalers with dose counters.

In the asthma-only subgroup, the incidence rate of respiratory-related and asthma-related ER visits during the outcome year was estimated to be 55% and 56% lower respectively in the dose-counter cohort. So what can primary care providers do? “They can tell their patients to request an inhaler with a counter, and to request a refill when it is low,”Meadows says.

“Patients needing more than one canister of albuterol a year are candidates for step-up therapy.” General practitioners often see patients with asthma, but in certain cases, it’s best to refer them to an asthma and allergy specialist.

“Certainly, any hospitalization should prompt a specialty evaluation. NIH guidelines suggest a specialist should evaluate patients that can’t be controlled on a medium-dose inhaled steroid for management,” Meadows explains.

“Additionally, milder patents might be referred for single visits to determine what they are allergic to and how to avoid it.”

—Colleen Mullarkey

Reference

Rigazio A, Buck P, Lepore M, Burden A, Gilchrist A, von Ziegenweidt J, Price DB. Integration of dose-counters into metered-dose rescue inhalers may reduce incidence of respiratory-related emergency room visits. ACAAI Meeting 2013; A5:11.