Thank you for the excellent review of asthma prevention, classification, treatment, and long-term management in your May 2005 issue ("Asthma Update: Pearls You May Have Missed," page 219). The summary by Drs Linda S. Nield, Lisa Markman, and Deepak M. Kamat should bring most of us up-to-date on the medications and ancillary tools helpful in managing this increasingly prevalent chronic illness.
I would like to add 2 comments.
• It is important to teach parents how to determine whether an inhaler is empty. I have had a number of patients come in with a cough who are "not getting better," only to find that their inhaler is empty. The propellant in the metered-dose inhaler may make the device feel as though it still contains medicine.
I instruct parents to take the pressurized tube and place it in a bowl of water. If it sinks, the tube is full. If it floats, the tube is empty.
• I find that using a written and color-coded Asthma Action Plan in the patient's primary language provides both an effective communication tool and a clear plan of action to enhance compliance with therapy, thereby preventing severe exacerbations. This plan is available from many state departments of public health or the National Heart, Lung, and Blood Institute. It can also be found online at various Web sites, including http://www7.health.gov.au/pq/asthma/pdf/ asthplnpad.pdf
----Jeffrey Zaref, MD, MPH Southboro Medical Group, Pediatrics Framingham, Mass
