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Arthur Bergner, MD; William A. Greisner III, MD; Renee K. Bergner, MD
University of Vermont College of Medicine Burlington

JAMA. 1993;269(12):1506.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—Asthma morbidity and mortality rates are on the rise and their causes are currently being addressed.¹ The appropriate role and use of β-agonist inhalers are being questioned.² We would like to call attention to a problem associated with the use of metered-dose inhalers (MDIs).

As is shown in the Table, MDIs contain sufficient medication for a specified number of inhalations.³

We believe that some of the exacerbations of asthma in our patients occurred when they continued to use their MDIs beyond the specified number of sprays.

As an inhaler is used, "the dose emitted by a large number of valves currently used seems to decline as the product is exhausted."⁴ When about 15% of the original amount of sus

pension remains, the meter chamber does not fill uniformly and subsequent doses fall below acceptable limits.⁴ The liquid propellant and decreasing doses of . . . [Full Text PDF of this Article]

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