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I experienced a knee-jerk reflex when I saw the picture on the front cover of the February 2010 issue of Canadian Family Physician. The cover shows a child with a pressurized metered-dose inhaler (pMDI) and no spacer. Good inhalation technique is primary and essential in the management of asthma. This picture clearly goes against everything that has been written in our Canadian Asthma Consensus Guidelines for years. It is well known and proven that the device consistently showing the poorest technique in children (or even in adults) is the straight pMDI. This is yet another of numerous examples in the press (medical or lay) in which the isolated pMDI is shown instead of a dry powder inhaler (more appropriate for a child of this age) or a pMDI with a spacer (second choice).
In my opinion and, I am as sure as can be, in the opinion of most of my colleagues, this picture perpetuates something that we have been trying to reeducate and inform family physicians about for well over a decade. I very much appreciated the articles in the issue, but this one image, in my mind, detracted so much from your messages as to make this issue of the journal detrimental to the practice of asthma in Canada.
I think, however, that we can look for a positive possibility here. I suggest that the next issue of Canadian Family Physician take the opportunity to correct the poor information inferred by the February cover image.