Article Text

Download PDFPDF
Do you know when the inhaler is empty?
  1. I Fullwood1,
  2. T Evans1,
  3. Benjamin Davies1,
  4. T Ninan2,
  5. C Onyon3,
  6. J Clarke4,
  7. Rajesh Srikanthiah5,
  8. Susan Frost1,
  9. N Iqbal6,
  10. M Atkinson7,
  11. Satish Rao1,
  12. Prasad Nagakumar1,8
  1. 1 Department of Respiratory Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
  2. 2 Department of Paediatrics, University Hospitals of Birmingham NHS Trust, Birmingham, United Kingdom, Birmingham, UK
  3. 3 Department of Paediatrics, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
  4. 4 Department of Paediatrics, Wye Valley NHS Trust, Hereford, UK
  5. 5 Department of Paediatrics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  6. 6 Department of Paediatrics, Walsall Hospitals NHS Trust, Walsall, UK
  7. 7 Department of Paediatrics, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  8. 8 Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Prasad Nagakumar, Paediatric Respiratory Medicine and Cystic Fibrosis, Birmingham Children's Hospital NHS Foundation Trust, Birmingham B4 6NH, UK; p.nagakumar{at}


Background Medication review is recommended at asthma appointments. The presence of propellant in the metered dose inhalers (MDIs) makes it challenging to identify when the inhaler is empty. The COVID-19 pandemic has resulted in move towards more virtual monitoring of care. We aimed to evaluate if patients identify when the inhaler is empty and the method of inhaler disposal.

Methods Prospective, multicentre quality improvement project. Data collected from children with asthma and other respiratory conditions.

Outcome measures Children/carers attending hospital were asked how they identify an empty salbutamol inhaler; dose counters in the preventer inhalers and disposal practices were reviewed.

Results 157 patients recruited. 125 (73.5%) patients deemed an empty inhaler as either full/partially full. 12 of 66 (18.2%) preventer inhalers with a dose counter were empty. 83% disposed their inhalers in a dustbin.

Conclusions Patients cannot reliably identify when their MDI is empty. There is an urgent need for improving inhaler technology and providing appropriate guidance on how to identify when an MDI is empty.

  • Paediatrics
  • Respiratory Medicine
  • Data Collection

Data availability statement

Data are available upon reasonable request. No data are available.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request. No data are available.

View Full Text


  • Twitter @prasadnagakumar

  • Contributors PN, SF, IF, BD, CO, SR, TE and JC designed the study. IF, BD and PN wrote the first draft. All authors contributed equally to the project. PN is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PN has received speaker's fee for talks in severe asthma from Novartis and GSK unrelated to this work.

  • Provenance and peer review Not commissioned; externally peer reviewed.