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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;270(17):2050-2051.

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

In Reply.

—Our letter attempted to address only the problem and potential consequences of asthmatics using MDIs beyond the number of sprays specified by the manufacturer. We limited the scope of the issue so that it could be supported by available evidence. However, many of our patients have volunteered their observations, which tend to confirm Weiss' personal experience, namely, that their sprays at times decline in force, volume, or effectiveness before the specified number has been used, even though they shake the MDI before each actuation.

Decreased dose problems are not more obvious to most patients for several reasons. Gradual changes of force, volume, or active ingredients are not easily perceived when sprayed into the mouth, and especially if a spacer (extender) is used. Patients generally do not count sprays and are not aware of how close they are to the end of the specified number of sprays. Therefore, when . . . [Full Text PDF of this Article]

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