After eight medical-mission trips to the developing world, I have learned how to make do with the resources that are available. When an asthmatic patient does not have the resources to purchase an inhalation spacer, a 16- or 20-oz plastic bottle will do. Cut out a hole just big enough to insert the end of the inhaler into the bottom of the bottle.

Instruct the patient to place the uncapped bottle opening in his or her mouth and the inhaler in the hole at the bottom. Instill one puff of medication into the bottle, and have patient take in several deep breaths until the mist of medication is no longer visible. Repeat if two puffs of medication are indicated. — Arden Moulin, WHCNP, Grapevine, Tex. (157-14)

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