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.

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The G.P.'s i work for often px an mdi but always through a volumatic/aerochamber. I also px this combination for patients during an exacerbation and with young children. I know i have educated them to not use the mdi on its own, but they still come back admitting that they found it easier to use without the spacer.When i check their technique it is always poor.The only way round this is to see them more often, but i see 720 patient/year and is not always achievable.

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I agree it is difficult to change attitudes of patients & that we can only do so much & it sounds as if you are one of the ones who do use research base evidence when pxing but it still does not happen in many areas. Should we not, if we know that it is poor practice, get the message across with campaigns like the recent handwashing etc with the help of BLF &/or Asthma UK? It will take time but the sooner we start the quicker it will take effect. What does Asthm UK feel?