Aerosol antiperspirants and axillary granulomata.

scored the top mark of five out of six: four were general practitioners and only one was a nurse (from the medical department). The paediatric nurses' scores were relatively high but they scored relatively few marks on refinements of technique. Nobody appreciated that any powder remaining in the opaque portion of the Rotacap does not emerge however hard the patient inhales. Although the instruction leaflet depicts loading the device with the mouthpiece down it does not say why and 62% of those who could load the device kept it horizontal throughout, expecting spillage. Delegation may sometimes be appropriate, but it was usually done without awareness of the competence of the delegate to teach. The general practitioners may have been more familiar with the devices because they had less opportunity to delegate. Follow up is usually performed by doctors and we will continue to be given clues by patients that their technique is poor. We must be competent enough ourselves to pick up these clues. Unless we handle and talk about these devices regularly with patients who use them day in and day out we will not remain familiar with the host of possible errors.