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William Weiss, MD
Hahnemann University Philadelphia, Pa

JAMA. 1993;270(17):2050.

	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.

—In a recent letter, Bergner et al¹ called attention to a problem in the use of metered-dose inhalers (MDIs) in the treatment of asthma: some exacerbations occur when patients use MDIs beyond the number of sprays specified by the manufacturer.

A related problem can occur when the dose per spray specified by the manufacturer actually delivered declines substantially before the specified number of inhalations is reached. Being retired, I can only provide evidence of this phenomenon from my own personal experience.

I have been using flunisolide inhalations (AeroBid with the company's spacer, Forest Pharmaceuticals Inc, St Louis, Mo) for the treatment of cough-variant asthma since 1990, using the company's directions. My dose has always been two inhalations twice a day and this is very effective in the control of my symptoms. However, after the 17th day of use I found that the strength of the spray declined . . . [Full Text PDF of this Article]

Footnotes
Edited by Drummond Rennie, MD, Deputy Editor (West), and Margaret A. Winker, MD, Senior Editor.

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