Patients often confuse their asthma pumps and medications and are unsure when to use each one. I have my patients bring all of their pumps to me and will write on the plastic canister with a Sharpie permanent marker: I write “quick relief and emergency” on the albuterol and “long-term control, use daily or preventative” on the steroid pump. — Robin Rivera, FNP-C, AE-C, Long Island, N.Y. (190-5)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.