Percutaneous fragmentation and dispersion versus pulmonary embolectomy by catheter device in massive pulmonary embolism.

Asthnia treat i t’nt CII1I)hasizeS inhaled medication’ to manage airway inflalllluatiou.2 Because ofdifflculties encountered in the USC of metere(l-(lose inhalers (MDIs),3 ‘ mansphysicians recommend spacers.5’ A .56-year-old man with steroid-dependent asthma, vasculitis, and bilateral vision loss secondary to retinal artery ()cclusn)n used oral theophylline. oral pre(lniS 11e, and inhaled metaproterenol, ipratropiIlfll, and trianK’illolone via NIDI. lie was stable until six Im)nths before 1)reSeIIt1tti Il, when symptoms worsened. Flunisolide was added sia Aerochamber (Monaghan Medical Cu, Plattsburgh, NY), but the SVIn )9)Ifls rapidly progressed. \%#{232} subsequently noted the patient inserting a UCW MDI into the spacer with the cap iI1 place (Fig 1). \\‘hen the NI DI was removed, the cap remained and was forced into the chamber with the next inhaler. After reinStrtlction, improvement ( )ccllrred, allowing tapering of oral c()rtic()steroids. Up to 5 I)erc’(’IIt of asthmatics forget to remove the cap within the spacer, which interferes with spacer function. This unique