Selective IgA Deficiency and Sarcoidosis

than one error simultaneously. We also studied the kind ofoutpatient contml, if any, devoted to these patients. As expected, the greatest percentage of errors was observed in the group of patients without any kind of medical advice (83%). However, practically the same proportion (79%) failed to use the MDIs properly despite the fact that they were under the supervision of medical outpatient care, either public or private. This proportion fell to 45% in our group of asthmatic subjects controlled by a member of our hospital staff. Our results do show both that MDIs are extensively used in a wrong fashion and also that the majority of patients &led in more than one ofthe recommended steps, reflecting the importance of the hand-lung problem. As suggested by Newman and Clarke, proper instruction is essential to teach the correct inhaler technique.' However, since both reported series on the bronchodilator effect of the patient's own technique and that from supervised administration by the physician have been contr~versial,~,' we suggest that a trial and error method may be the best way to achieve maximal bronchodilator response. In other words, if the asthmatic patient does feel the airway penetration of the nebulized particles, regardless of method, maximal therapeutic effect may probably be achieved, which essentially is the cornerstone of medical advice.