# Asthma and Ventolin



## TR5 (Jun 6, 2007)

If you are asthmatic and use Ventolin, you may be interested to know that I have found that many ventolin inhalers are short-changed on the dosage.

I have found that the 20g of sulbutamol sulphate that is supposed to provide the 200 doses, is often significantly short, sometimes even empty.

As a user, Ihave found this problem has been going on for several years to my knowledge, although GlaxoSmithKline, the manufacturers deny there is an ongoing problem, and tell me to take them back to Boots (the dispenser) for exchange.
However, Boots will not exchange without a further prescription and also want the original box.

This may seem an unsignificant thread, but if you have gone out for the day with a new inhaler, needed it, only to find it is empty, this could be a serious medical situation you have been put in.

If you have access to letter scales, or can weigh in grammes, this is what the package should weigh:

Ventolin Inhaler + box and leaflet: 50g (new - unopened)
Ventolin Inhaler (full - no box): 40g
Ventolin Inhaler empty: 20g

Each gram provides 10 doses, each inhaler is supposed to provide 200 doses, so an inhaler which is 8g short of what it should weigh, is short of 80 doses. 

Has anyone else found or suspected that their Ventolin has not been full ?


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## suedew (May 10, 2005)

What a frightening thing to happen. Don't need to use mine much now (fingers crossed and touching wood) but am never without one.
You must be very unlucky. in 20 years of using inhalers I have never had a problem. add to that 30 years of giving the medication in a hospital setting.
Do you always get your inhaler from the same pharmacy? wonder if the problem is there and not with the manufacturer. Someone just might have a friend who uses inhalers and pays for prescriptions :roll: 
Mind I do have a nasty suspicious mind.
Can't understand why the manufacturers don't use inhalers with dosage counters like seretide/servent.
Hope you get it sorted out soon
Sue


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## bobandjane (Dec 29, 2007)

I am sorry I cannot remember the name of it but when our eldest got Asthma she was prescribed her meds (two sorts including Ventolin) in something that looked like a giant smartie, might be called an Accuhaler. Anyway the benefits of this are ! Each dose is unwrapped from a blister as you open the 'smartie' for want of a better word and all you do is breath it in through the mouthpiece. The way the air travels through it means it sucks the powder up and puts it where it does most good... your lungs. There is no timing involved like the other system and you do not need a spacer (more like a Space Ship) either if you are not good at synchronising it all. Foe something so important though you would think they would get the other doses right! Jane


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## TR5 (Jun 6, 2007)

Hi Sue

The packs are sealed, so they are not tampered with. It is a manufacturing problem, and many woul not know unless they actually have an empty one, or the means of weighing each inhaler before use.

Most commonly, they are short of product, and I returned two just today to Boots, in the hope they will take it up with GSK.

One was 34g - 6g short, the other was 24g - almost empty!

I would say that at least one in ten are not full, and possibly one in 20 or 30 are actually empty, or near empty.

Not good if you suddenly need a "good dose" to ward off an attack.


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## suedew (May 10, 2005)

TR5 Hope it gets sorted for you and everyone else soon.
for the other poster, have forgotten ypour name sorry
The dischalers are much less effective the powder landing mostly in your mouth not your lungs.
Accuhalers are a bit like normal inhalers with an extension.
The old spacers were huge, they are still available and some people prefer them.
New spacers eg aerochamber are small enough to fit in my handbag,( not those little night club purse things though)
Spacers are recommended for a few reasons, the main one being that the amount of medication getting to the lungs is increased by about 10 fold therefore is more effective.
In an accute asthma attack it can be difficult to 'manage' inhaler, a spacer with a face mask requires no extra effort to get the medication.
In jubilation at retiring I recycled all my data thinking I would no longer require it so am unable to give exact figures.
Still most important thing as TR5 points out is having the medication in the first place.
Not sure if I will be taking the scales to the pharmacy when i get my next lot though.
Sue x.


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## jncrowe (Feb 14, 2009)

*inhalers*

i used ventolin (puffer type)inhalers for years and was not happy
as you say they used to vary in the time they lasted and some puffs worked better than others
my GPs pharmacy lady reccomended the ventolin accuhaler and they are very reliable
the dosages are numbered so that you know exactly how many (sucks) are left 
in many years ive only been prescribed one that was faulty and i took it straight back to the chemist and they swapped it 
all the best 
cath


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## Waleem (Nov 1, 2006)

My Asthma was poorly controlled on Ventolin and Becotide for years. My Wife started to work for AstraZeneca, who make "Turbohalers"-they don't contain gases, you just breathe in-no waste and very accurate delivery. I asked my Doctor if I could try Symbicort Turbohalers-these are a combination of preventer and reliever. I take mine one puff once a day and my asthma is now completely controlled, in fact I no longer carry my Turbohaler unless I have a cold etc. (I have been virtually symptom free for nearly 10 years.) The benefits as I see them:

One inhaler instead of 2 (Cheaper prescriptions)
No waste
Better delivery system/drug effectiveness
Cuts or eliminates the use of a reliever (Certainly in my case)

I should add that my Wife no longer works for the company so I have no bias, but am just telling you all this as a VERY happy customer !!


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## Penquin (Oct 15, 2007)

TR5 said:


> IIf you have access to letter scales, or can weigh in grammes, this is what the package should weigh:
> 
> Ventolin Inhaler + box and leaflet: 50g (new - unopened)
> Ventolin Inhaler (full - no box): 40g
> Ventolin Inhaler empty: 20g


Were those figures supplied by the manufacturers?

They seem very precise and I assume that the balance on which you weighed em (if you did) was accurate. We have a big problem finding electronic balances that give precise, accurate, reliable figures. Most balances are capable iof giving a DIFFERENCE in mass accurately (the mass now is 44g and was 48g) but if you weigh two items of known mass of say 50g the absolute values are not precise.

That is not me being pedantic, there is a specific reason - if your balance is accurate to say + 5g (quite a common figure) the article could weigh between say 46 and 54g quite reasonably for a known 50g mass. That would suggest an error in the fill which would be significant (using standard statistical analysis of significance of +5% difference).

Our lab balances are quoted as + 0.01g but no two balances give the exact same answer...........

I would be delighted to know where you obtained your figures and will check the sealed Ventolin (salbutamol) boxes that i have available to see if there is a major discrepancy.

An interesting thought and one that a pharmacist would be required to follow through using the "yellow form" system since it could potentially put someone's life at risk if their new inhaler did not contain any medication.

It is also, of course, quite possible that the missing mass is due to a lack of propellant NOT a lack of salbutamol. The propellant used in many is now hydrofluoroalkane, or HFA 134a c/w the previously used chlorofluorocarbons (CFCs). I believe that if the propellant was reduced the inhaler would still deliver salbutamol but not for as many doses since the propellant would run out.

Dave


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## TR5 (Jun 6, 2007)

Dave

I have used Ventolin for probably 35+ years, and have suspected the inhalers to be short of product for quite a number of years, and especially since going over to CFC-free propellant.

I have been weighing the inhalers for the past year before making this statement, and have digital letter scales that weigh in increments of 2grams, up to 2000g - purchased via Viking Stationers, and used for letter postage weighing. If a weight is inbetween two grams they flash between the two weights either side, so they are accurate enough for my analergy. Over the past year or so, I have found 2 empty, and 4 seriously under-filled, as well as probably a couple more which are not totally full.

I have weighed empty ventolin inhalers (20g), the information leaflet and the box states 200 doses of 100mgram, i.e. 0.1gram per dose, which fits in with the weight of a full ventolin of 40g. The packaging weighs 10g - so unopened the package should weigh 50g, and weighing for the last year confirms this.

As I have both home, my motorhome, and a holiday home, I have always kept stock at all three, so I never run out, so had probably about eight to check initially, plus replacements since.
The figures are accurate enough for my purpose.

John

I too have been taking Symbicort 200 - 2 inhalations twice a day, for the past year and have found an improvement over using becatide and seravent previously, and now use the ventolin a lot less, although I also always carry one on me, and a spare if away from a source, having been hospitalised twice over the period of time having asthma. If on holiday I always have at least two spares, depending on time away, and carry a photocopy of my prescription, just in case.

I have found that a chemist will sell you ONE inhaler if you get caught out away from home.

As said before, and forgetting the cost implication, if needing the inhaler and thinking you have a new full one with you, and upon opening find it is either empty or reduced capacity, it could be a medical risk - that is my concern.
Some people rely on ventolin more than others, but during an asthma attack you may need to take a considerable amount over a very short period of time. I am trying to assertain if others have found, or suspected the problem stated, and to forewarn those who may not have noticed, but have the ability to check by weighing.


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## Penquin (Oct 15, 2007)

TR5 said:


> I have weighed empty ventolin inhalers (20g), the information leaflet and the box states 200 doses of 100mgram, i.e. 0.1gram per dose, which fits in with the weight of a full ventolin of 40g. The packaging weighs 10g - so unopened the package should weigh 50g, and weighing for the last year confirms this.


Ref; Wikipedia;
http://en.wikipedia.org/wiki/Microgram

100 micrograms is NOT 0.1g. 1 microgram is 1 *millionth* of a gram so 200 doses of salbutamol at 1 mg / dose = 200 x 0.000001 g = 0.0002g *NOT* 20g.

You have ignored the mass of the propellant as I suggested.

Balances are NOT that accurate as I said, our balances cost in excess of £K10 as they are used for analytical chemistry and even at that quality the results vary from balance to balance and time to time. So your balance would not give a sufficiently accurate result. They would not be able to weigh to 4 decimal places of 1g and are accurate to + 2g ASSUMING that they are accurately zeroed before every use.

I respect that you have taken measurements and your results appear to lead you to that conclusion but as far as I am aware you are the only one that has reported that problem and if it was as widespread as you believe there would be a massive investigation launched by the British Pharmaceutical Association under whose authority ALL prescriptions for POM medication is dispensed.

If you are seriously concerned (and from your posts I believe that you are) check with a pharmacist in an indpendent pharmacy where the same staff have an on-going repsonsibility to their customers; ask them to check the mass of a new inhaler cylinder (not the packaging or the actual inhaler but just the full cylinder) before they dispense it to you and ask them to check with the manufacturers what the mass should be. The manufacturers should be able to supply accurate information, but even then the balance that the phramacist uses will not be able to read the 0.0002 g due to the salbutamol.

Dave


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## TR5 (Jun 6, 2007)

Dave

I have weighed 3 new ventolin inhalers which I obtained yesterday, all three weighed exactly 50g, including the packaging -so are deemed full.

I also had one older inhaler which was almost out-of-date.

When weighed, it registered (out of the packaging) 32g, so I wasted it - i.e. I used the inhaler to atmosphere and counted the number of "puffs" until it was exhausted - there were 123.

That is conclusive enough to me that the weight/dosage ratio is relevent, and that I have had a considerable number that has been under-weight, so dose-short. 

Dave, please don't try and fluff me with science, ok each dose contains the propellent and maybe other properties, but the fact is that an empty inhaler weighs 20g, and a full inhaler weighs 40g, and is supposed to supply 200 metered doses, so there are 10 doses to the gram, whatever it contains or includes.

I am not complaining of inhalers being 1g short, but some are 50% short, and I have had ones that are empty - FACT!

Unless you have suffered receiving an inhaler which is empty, you probably wouldn't even notice (without weighing or counting the doses) that some are short!

PS. My letter scales have been used for a number of years, to weigh letters, and the results have always matched that of the post office scales. And it self zero's on each use. That's good enough for me to prove the point.


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## Penquin (Oct 15, 2007)

TR5 said:


> DavePS. My letter scales have been used for a number of years, to weigh letters, and the results have always matched that of the post office scales. And it self zero's on each use. That's good enough for me to prove the point.


That is your opinion and there are times when to continue a discussion is pointless, this is one of them.

Dave


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## TR5 (Jun 6, 2007)

I know this is an old thread, and I am not arguing with anyone, but want to point out that I have just opened a new Ventolin Evohaler, in a sealed box - prescribed 27/10/2011 so 1 year old, but with an expiry date of July 2013.

It is empty!

I now use Symbicort 200 - two puffs twice a day, which controls my asthma much better, so use the Ventolin rarely, and in fact throw away 1 in 3 due to being out of date.


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## bigbazza (Mar 6, 2008)

I threw a brand new Ventolin inhaler away yesterday (expiry date July 2013) which although felt full when shaken, it had lost most of it's propellent and gave out just a tiny amount inhalent.


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