Design:  Peak Inspiratory Flow Rate ( PIFR ) is the most important factor for lung delivery of inhaled medicines . It should be above 60 L/mt , for effectiveness ; But routinely physicians do not have the test meter at their office , to see whether the pt is getting the medication ; In my experience , many of the adult Asthmatics , with comorbidities as , OSA/ Heart problems , do not seen to generate that pressure , yet say they are using it correctly ; So I decided to give spacer / MDI to 20 adult asthmatics , ( FEV1- >70%) ad 20 others without a spacer for 3 months ;

Main Findings:  Total Pt enrolled = 40/ M:F 56/45 ; FEVI= range - 72-75 %

Impact on Practice:  Neb treatment is advised for asthmatics , whose PIFR is below 60L/mt ; But PIFR measurement is not routinely available for office use . Even though we demonstrate the correct use of MDI at our office , and pt understands the use ; the fact is , Asthmatics with co -morbidities , show improvement in the lung function , with spacer device ,

Submitted by Joe Theck from Allergy immunology Center