To the Editor.
—In light of the article by Tobin in the September 1985 issue of the Archives,1 we are writing to report a previously unpublished problem with a spacer-inhaler (Brethancer). The spacer-inhaler unit is a compact combination metered dose inhaler adapter and collapsible tube-type spacer. Recently, a long-term asthmatic patient was started on therapy using the terbutaline (Brethaire) with the adapter (Brethancer). One month later, the patient returned to the clinic, complaining that the new system was not working as well as his previous one. On examining the adapter unit, it was found that the "flap" portion of the middle section had come out of the retaining grooves, and was fixed in a closed position at all times. On disassembly of the unit, this flap was found to be caked on the concave side with a whitish pasty substance, which was assumed to be the drug. With some