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Inhalation with spacer
  1. Martin H Schöni1,
  2. Jürg Barben2
  1. 1
    Department of Pediatrics, Inselspital, and University of Berne, Berne, Switzerland
  2. 2
    Department of Pediatric Pulmonology, Children’s Hospital, St. Gallen, Switzerland
  1. Martin H Schöni, Department of Pediatrics, Inselspital, Berne, CH-3010, Switzerland; martin-heinrich.schoeni{at}

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We read with interest the original article by Cohen et al about prescribing asthma drugs, which was published in the October issue of this journal.1 The paper reports, in line with other publications, the difficulty of implementing asthma guidelines. Indeed, it is a challenge for all professionals who prescribe inhalation therapy to achieve good adherence to proposed and validated asthma treatment.

In the same volume of the journal, a thoughtful article about the safeguarding of children being the responsibility of everyone, especially the caring doctors, is published.2

In the view of these two articles, we see it as our responsibility to point out to the readers that the picture on the cover of the issue of a girl inhaling with an pressurised metered dose inhaler (pMDI) neither agrees with the international guidelines for applying inhalation therapy nor fulfils the criteria for safeguarding children from wrong inhalation procedures. In fact, it is poor publicity for a journal such as the ADC that the simple measure of using a spacer for pMDI inhalation is not shown on the front cover. For many years we have tried to teach that inhalation devices for children should be used only with appropriate chambers. All guidelines, as published for instance by the Global Initiative for Asthma (GINA, 2006)3 or in papers of this same journal,4 5 heavily recommend the use of spacers in children inhaling asthma medication by pMDI.

There is no doubt that the picture on the cover of Vol 92, No 10, is intrinsically wrong and a bad example for readers of the journal.



  • Funding: None.

  • Competing interests: None.

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