I have read with interest the article "Comparison of patients' compliance with prescribed oral and inhaled asthma medications" by Kelloway et al.1 As an allergist, I am very concerned that patients are frequently noncompliant when using inhaled steroids. I am also concerned with the lack of compliance by physicians as to recommendations by authorities in the field.2-5 It is well known that a significant portion of the population cannot use metered-dose inhalers correctly without a spacer device. This is especially true of the very young and the elderly. Spacer devices decrease the adverse effects associated with the use of inhaled steroids, such as oral candidiasis and voice changes, while also increasing lung deposition. The purpose of this letter was to determine if physicians were dispensing spacer devices with inhaled steroids.
To determine if patients received a spacer device with the inhaled steroids, I surveyed patients by telephone. The