The Woolcock Institute of Medical Research

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 of Medical Research, 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 the 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 the 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 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.

This article was first published at ajp.com.au.