Use of MDi without spacers

Whilst I accept that the device a patient uses should suit them and not the professional, why, when there is evidence to show that using MDI's without some sort of spacer (i.e. directly into the mouth) is really a waste of time & effort, do we still see picture of people with the MDI in the mouth?

I don't believe that patients are asking for MDI's in preference to other types either. In my case load we assessed patients for other types of devices and have requested GP's continue them type to be told by the family the next time we see them that when they ask for a repeat prescription they get an MDI and are told they cannot have the other and oftern told it cost more. This is false economy as they end up using more MDI's which cost more because patients run out quicker and they don't get good control.

Why aren't nurses/dr's who care for patient's who need inhalers moving them on the the many other types which have better deposition that the 4% they get from MDI's?

Should there not be a be a campaign particularly with heath professionals and site like this, to highlight that this is not best practice?

I would be interested in hearing what others feel.