New puffers with dose counters incoming

Ventolin inhalers with a dose counter are now listed on the PBS, with a full transition to the new design expected by end of 2020

A dose counter has been added to Ventolin (salbutamol sulfate) metered dose inhalers for Australian patients living with obstructive airway diseases, such as asthma and chronic obstructive pulmonary disease (COPD).

The integration of a dose counter with the Ventolin inhaler will allow patients to view the number of doses remaining in their inhalers, says sponsor GSK Australia.

It will be the first asthma reliever medication that has a dose counter in the same way that preventers medications have had for years.

A transition to the new Ventolin with dose counter will occur over 4-6 months, while existing stock of Ventolin continues to be sold in pharmacies.

GSK said there may be limited availability of Ventolin with dose counter in the early months, although it expects a full transition to be complete by the end of 2020.

“After this time, all Ventolin inhalers available to patients will have a dose counter,” said the company.

Meanwhile GSK said healthcare professionals should advise patients to expect to receive their regular Ventolin inhaler (without a dose counter) until the transition period is complete.

The updated inhaler is being reimbursed on the Pharmaceutical Benefits Scheme (PBS) from 1 August.

For PBS dispensing to general patients, the Ventolin with dose counter will cost $1.31 more per inhaler. There is an increase of 67 cents per Ventolin inhaler with dose counter for patients who hold an eligible concession or pension card.

Professor Sinthia Bosnic-Anticevich, a professor at the Woolcock Institute, University of Sydney and team leader of the Quality Use of Respiratory Medicines group, told AJP the first thing pharmacists need to do is reassure patients that the medication itself is the same and the big difference is that it has a dose counter on the outside that is visible to the patient.

The addition of a dose counter provides a “real opportunity” for pharmacists to engage with patients who use Ventolin, she said.

“We know that about 50% of people who have poorly controlled symptoms actually think they have well-controlled asthma,” said Professor Bosnic-Anticevich, who has been working in the area of respiratory medicines for 20 years.

“So those people, if they’re actually monitoring their Ventolin use, will actually be able to see how often they’re using it, they’ll see that the dose counter is going down – they’ve never been able to see that in an objective way before.”

If there is an indication a patient is using their reliever more than twice a week, pharmacists can then look into other facets of their medication management, she suggested.

“Are they actually taking their preventer medication, do they have correct technique, are they on the most appropriate device for them, are they on the appropriate dose, do they have co-existing allergic rhinitis? Then we can start to have a conversation.

“It is a challenge for pharmacists to have a conversation about reliever use because patients know about it, they’ve been using it for a long time, it can be difficult for us to have an impact because these patients are very experienced with their asthma,” said Professor Bosnic-Anticevich.

“But this is something different, this is something that the patient can use themselves to help them be realistic about how often they’re using it and it’s a fantastic opportunity for pharmacists to have a conversation.

“If we can get patients to actually reflect and think about how much reliever they’re using, that’s a really important step in us having conversations about their level of asthma control, their use of preventer, to reduce their symptoms and minimise risk of flare-ups.”

The new Ventolin inhalers will come with 200 doses, although the counter will read 204 on a new inhaler, GSK confirmed to AJP.

If a Ventolin inhaler is new and has not been used before, patients should release four puffs into the air until the dose counter reads 200 to make sure that it works, they advised.

Ventolin has been in high demand in since the start of the COVID-19 pandemic, however GSK confirmed last month that there are good stock levels of the medicine across the country.

GSK has established a helpline for patients and healthcare professionals to ask questions about the new product on 1800 318 180.

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  1. Bruce ANNABEL

    What a wonderful innovation for we who are afflicted by asthma and a person who has been using Ventolin ever since it came on to the Australian market many decades ago. Thank you GSK!!

  2. Debbie Rigby

    Hopefully this change will prompt a discussion with patients on over-reliance on salbutamol by many people with asthma. Use 2 or more times a week indicates suboptimal control of asthma. Patients should only use 2 canisters per year. And anti-inflammatory relievers are now on the PBS for adults and adolescents which significantly reduce the risk of severe exacerbations.

    • John Roberts

      In THEORY, that would be wonderful Debbie. As a person who was using asthma preventatives BEFORE Ventolin, ie. theophylline – Elixophyllin, suppositories (the latter in my opinion giving the longest-lasting bedtime relief from severe asthma attack), I feel I know a little about this. Regretfully, the theophylline slowly stopped working for me so by the 1990s I was moved onto corticosteroids.

      The reality is that long-term use of steroidal long-acting preventatives, as collateral damage from relaxing the muscles / airways to reduce asthma, relax the oesophageal sphincter causing gastric reflux in older people. This gastric reflux is not like heartburn – it is like the pain of a full-on heart attack, with doubling-up, swearing, completely ignoring others, blindly trying to find a way to kill the pain. It eventually passes, of course. Zantac and Nexium were useless. I was on four large bottles of Gaviscon a month before I discovered herbal tea was more helpful for me.

      However, the constant washing of stomach acid over the lower end of the oesophagus causes the body to turn it into bowel-like lining in an attempt to reduce damage. But it is not the bowel, so this then raises the risk of oesophageal cancer. The poor unfortunate now needs to be on three-yearly scans of his oesophagus for the rest of his life.

      Furthermore, moving from R12 to R134a propellant DRAMATICALLY reduced Ventolin’s effectiveness in my opinion. What used to take one puff to provide relief and a yawn (the latter showing expulsion of carbon dioxide buildup during the attack from the blood) took more puffs with the new propellant. The new Ventolin counter mechanism now reduces airflow and hence medication into the lungs – meaning the inhaler has to be used even more to gain the same effect. Remember, the more open the flow, the better the medication is absorbed (the idea behind holding chambers).

  3. Steve

    Yesterday I just tried the latest Ventolin with the counter and I think it’s AWFUL.
    Airflow on inhaling is severely restricted compared to the previous version and I felt like I do not get the gas travelling fast enough to completely get into my lungs.
    If only we could go back to the Ventolin of 10 or 15 years ago, where they used a heavier gas and it penetrated better. But, they changed it due to CFC regulations (or whatever). To compensate, the use of a spacer was recommended but I never found that device effective.

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