To the Editor.
—For the last several weeks you have published an advertisement for Tilade (nedocromil sodium, Fisons Corporation, Rochester, NY).1 On the third page of this insert is a photograph of a man using this metered-dose inhaler (MDI)—incorrectly.Metered-dose inhalers work better, in general, with a mechanical spacer or a 2-cm gap between the outlet and the lips. Using the inhaler as pictured, with the device jammed inside the mouth, results in deposition of the medication on the posterior pharynx rather than in the lungs.Physicians reading The JOURNAL should teach proper use of MDIs and not as pictured.
Newman DM. Metered-Dose Inhalers: Mouth Open or Closed?. JAMA. 1994;271(4):272. doi:10.1001/jama.1994.03510280034023