I can see this  being an issue with as needed meds that you do not take ona
regular schedule but it shouldn't be much of an issue with daily maintenance
meds. Just use a calendar.

Personally I've never really understood the advice to wait between puffs of
MDI's. If things are severe enough that drug may not be getting down deep
(which is pretty severe) I can see waiting a bit to let the lungs open some
but this is not an issue for maintenance meds or even rescue meds if not
having a severe attack.

When you take a breath some of the air makes it down to the gas exchange
area and some gets stuck in the air passages (the "dead space"). When you
blow the air out of your loungs you are emptying the exchange areas mostly
and to a lesser extent the dead space. When you breathing and tale a puff
the first bit of air has nothing then there are increasing then decreasing
concentrations of drug. While you hold your breath drug in the air gets a
chance to diffuse out of the air and into the respiratory secretions lining
the lung surfaces and the drug equilibrates between all the spaces. When you
breath out there is still drug left in the remaining gas exchange areas and
the dead spaces. I don't really see the advantae of waiting for the next
puff and just breathing that drug out.

What I do is blow the air out and then puff as I inhale. Then hold my
breath. Then breath out fully and immediately take another deep breath with
the second puff and hold that again. This way you re-use the drug that was
left over after the first puff. it makes much more sense to me and is much
easier than sitting there for some time between puffs.

In reality the amunts of drug are probably small and it probably all makes
very little difference. AT least my way is faster and more conveniant.

I forgot to mention - the new Ventolin HFA inhaler comes with a dose
counter.

So does the Asmanex steroid dry powder inhaler.