The excellent article by Skorodin1 detailed many current aspects of thinking, practices, and controversies in the treatment of asthma and chronic obstructive pulmonary disease. It is apparent that he is cost-conscious and thorough in his approach.
Our original belief, shared by many others,2 was that we could train and educate patients in proper use of metereddose inhalers. However, after two decades of trying, we now believe that all patients with chronic obstructive pulmonary disease and asthma deserve their own personal aerosol reservoir to bring with them to the emergency department, ward, intensive care unit, spinal cord unit, or any other part of the hospital.3-6
We will still need a few nebulizers for sputum induction, but the new developments in aerosol reservoir technology and delivery systems (masks and adapters) have made it almost impossible for us to identify a patient who requires the costly and inefficient, cumbersome nebulizer