This is one of my favorite (not!) Answers when I ask one of my patients why they come to class wheezing and barely able to breathe. I have to pause before I figure out how to tactfully ask the question: You know you need your inhalers, so, how could you not know you were running low?

And then the REAL question: if this person refills their inhaler regularly, every month, then how is it they ran out?

Have you possibly been using your inhalers 'as needed' more often than usual?

This happens to many patients. You are going along fine, 2 puffs 4 times a day, then the weather changes. Or you get a mild cold. Or something stressful starts happening. Next thing you know, your inhaler is empty and you have another 5 days before you can get a new inhaler.

Everyone takes extra 'rescue' puffs once in a while. But it's important to keep track of how many of these extra puffs you are taking in a day, and why.

Some inhalers come with a built in counter, to let you know when you are near the bottom of the canister. Even with a counter, it is a good idea to make sure you have enough medication, so it will be there when you need it the most. Make a habit of looking at your counter on the 15th of the month. If you have used more than half of your doses, it's time to talk to your doctor.

Yet, some insurances will only pay for one inhaler per month. What can you do in this situation? Many people will pay the cash price for one more rescue inhaler to have on hand. Your doctor should not have any problem writing a prescription for you for this.

With asthma, we divide the diagnosis into 'controlled', 'poorly controlled', and 'uncontrolled'. Controlled means that the indications are doing their job and the patient has very few exacerbations or episodes of short breathing.

“Poorly controlled” means the patient has many episodes or exacerbations that often send them to the hospital. “Uncontrolled 'means nothing we prescribe is working, or, the patient is not compliant with the medications and inhalers that we do prescribe.

This goes for COPD as well. I had one patient who was taking one puff of his inhaler every hour. That is not a symptom-control strategy!

If you find that the inhaler regimen you have been prescribed just is not covering you and keeping you symptom-free, it's time for a medication review with your doctor.