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Communications to the Editor |

The Doser External Counting Device FREE TO VIEW

Dennis M. Williams, PharmD; Andrea Wessell, PharmD(c); Tina Pennick Brock, MS
Author and Funding Information

University of North Carolina School of Pharmacy, Chapel Hill, NC; Dr. Williams is Assistant Professor and Clinical Specialist in Pulmonary Medicine and Ms. Brock is Clinical Assistant Professor.

Correspondence to: Dennis M Williams, PharmD, University of North Carolina at Chapel Hill, School of Pharmacy, CB #7360, Beard Hall, Chapel Hill, NC 27599-7360



Chest. 1999;116(5):1499. doi:10.1378/chest.116.5.1499
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Published online

To the Editor:

The Doser (Meditrack Products; Hudson, MA) is an external counting device for metered-dose inhalers (MDIs). It attaches to the top of an MDI canister and records actuations as the canister is depressed. The Doser tracks the number of actuations remaining in the canister and those used each day. Accuracy of the Doser was established in a study comparing it with a diary and the Nebulizer Chronolog, an established microelectronic monitoring device.1

We performed an evaluation of six Doser devices used with four fluticasone (Flovent; Glaxo Wellcome; Research Triangle Park, NC) and four albuterol (Ventolin; Glaxo Wellcome; Research Triangle Park, NC) MDIs. Correlation between Doser results and manual actuation counts was good, with a Doser SE error rate of ± 4.5%. In seven of eight cases, however, the Doser overestimated actual actuations (102 to 107% of doses). In the remaining instance, the device registered 99% of doses actuated.

We identified two potential concerns related to use of the Doser. While information from a published report1and the Doser Web page2 indicated that the device should not be used with ipratropium, cromolyn, or nedocromil, the product labeling and accompanying package information did not include statements about these specific products. We were able to attach the Doser to the ipratropium bromide (Atrovent; Boehringer Ingelheim Pharmaceuticals, Inc; Ridgefield, CT) canister; however, the fit did not allow correct seating of the canister nozzle into the mouthpiece. Subsequently, when actuated, the dose was not released or only partially released, although the device indicated that the dose had been delivered. With this in mind, patients unaware of the recommendations against the use of this device with ipratropium bromide MDIs may not receive accurate doses of ipratropium despite the readings of the Doser.

The second observation about the Doser is related to problems using the device with longer MDI canisters, particularly those for albuterol. The 8-cm long albuterol canister extends to 10 cm with the counter in place. When holding this Doser-MDI combination between the thumb and forefinger, the distance may be too far for some patients to actuate comfortably. This may be difficult, especially for arthritic patients, children, or other persons with small hands.

Although the Doser may be a useful external counting device, clinicians should be aware of these issues when recommending the product for patients.

References

Simmons, MS, Nides, MA, Kleerup, EC, et al (1998) Validation of the Doser, a new device for monitoring metered-dose inhaler use.J Allergy Clin Immunol102,409-413. [PubMed] [CrossRef]
 
Meditrack Products. Doser. Available at: http//www.doser.com. Accessed June 2, 1999.
 

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References

Simmons, MS, Nides, MA, Kleerup, EC, et al (1998) Validation of the Doser, a new device for monitoring metered-dose inhaler use.J Allergy Clin Immunol102,409-413. [PubMed] [CrossRef]
 
Meditrack Products. Doser. Available at: http//www.doser.com. Accessed June 2, 1999.
 
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