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Can Fam Physician. 2010 April; 56(4): 329–330.
PMCID: PMC2860820

Cover concerns

I am writing to add to Dr Spier’s comments regarding the February 2010 cover of Canadian Family Physician. I agree with Dr Spier, who notes that this child is too young to use a metered-dose inhaler alone. However, I have 2 additional concerns:

First, the asthma articles in the February issue (commentary on long-acting β2-agonists1 and the debate on spirometry2,3) both mainly address adult asthma. Long-acting β2-agonists have much more evidence demonstrating efficacy in adult asthma,4,5 although a very recent article has suggested they might also have a role in pediatric asthma.6 All the articles cited in the commentary by D’Urzo et al1 discuss adult asthma. Similarly, while spirometry is an important tool in the management of asthma in children 6 years of age and older, the debate2,3 argues its role in diagnosing asthma in adults and differentiating asthma from chronic obstructive pulmonary disease. I realize that an image of a sick child is more dramatic and gripping than a photo of an adult; however, this photo is unfair to children, as the articles really do not address pediatric asthma, and is equally unfair to adults, who have a right to have their asthma recognized.

My second concern is that it seems that every photo used of someone with asthma depicts someone using one of the familiar “blue inhalers.” Recent guidelines have emphasized that really any use of a rescue bronchodilator inhaler represents a failure of both asthma control and successful asthma management.7 We need to reshape people’s perception of asthma from being a disease in which patients frequently need bronchodilators to relieve symptoms to one in which patients—apart from taking their preventive, “earth-toned” inhalers—go about their active daily lives. If the cover needs to show someone with asthma using an inhaler, it is time that it is an image of someone using an anti-inflammatory, preventive inhaler (and using the appropriate device, with good technique).


1. D’Urzo AD, Jugovic P, Bouchard J, Jhirad R, Tamari I. Safety of long-acting β2-agonists in the management of asthma. A Primary Care Respiratory Alliance of Canada perspective. Can Fam Physician. 2010;56:119–20. 123–4. Eng. (Fr). [PMC free article] [PubMed]
2. Kaplan A, Stanbrook M. Must family physicians use spirometry in managing asthma patients? Yes. Can Fam Physician. 2010;56:126, 128, 130, 132. Eng. (Fr). [PMC free article] [PubMed]
3. D’Urzo AD. Must family physicians use spirometry in managing asthma patients? No. Can Fam Physician. 2010;56:127, 129, 131, 133. Eng. (Fr). [PMC free article] [PubMed]
4. Verberne AA, Frost C, Duiverman EJ, Grol MH, Kerrebijn KF. Addition of salmeterol versus doubling the dose of beclomethasone in children with asthma. The Dutch Asthma Study Group. Am J Respir Crit Care Med. 1998;158(1):213–9. [PubMed]
5. Kovesi T, Schuh S, Spier S, Bérubé D, Carr S, Watson W, et al. Achieving control of asthma in preschoolers. CMAJ. 2010;182(4):E172–83. Epub 2009 Nov 23. [PMC free article] [PubMed]
6. Lemanske RF, Jr, Mauger DT, Sorkness CA, Jackson DJ, Boehmer SJ, Martinez FD, et al. Step-up therapy for children with uncontrolled asthma while receiving inhaled corticosteroids. N Engl J Med. 2010;362(11):975–85. Epub 2010 Mar 2. [PubMed]
7. Lougheed MD, Lemière C, Dell SD, Ducharme FM, Fitzgerald JM, Leigh R, et al. Canadian Thoracic Society Asthma Management Continuum—2010 consensus summary for children six years of age and over, and adults. Can Respir J. 2010;17(1):15–24. [PubMed]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada