[Evaluation of the everyday use of a metered dose aerosol triggered by inhalation (the "Autohaler" system)]. / Evaluation de la manipulation en pratique courante d'un aérosol-doseur déclenché par l'inspiration (systéme Autohaler).

Although corticosteroids or beta2-agonists administered by inhalation are recommended as a first line treatment of asthma, standard pressurized metered dose inhalers are used correctly in only 3-% of cases. This study on the new breath-actuated inhaler Autohaler fulfils two objectives: first, to evaluate the respective influence of the reading of the instruction notice and the prescriber's explanations on the correct use of the Autohaler and second, to determine the profile of subjects most refractory to its correct use. The study was conducted by general practitioners in 2,467 asthmatic subjects with poor inhaler technique. The Autohaler was used correctly right from the start in 42.8% of subjects simply after reading the instruction notice (phase I) and in 68% of subjects after receiving the prescriber's explanations (phase II). At the end of phases I and II, correct use was performed by 82% of subjects. After stratification and adjustment, the probability of incorrect use, derived from the odds ratio: i) increased by 80% between 35 and 64 years of age and by 280% beyond 65 years; ii) was 30% higher in cases of severe asthma; iii) was 50% higher in cases of regular use of a pMDI and 80% higher in the absence of previous treatment with inhalers; iv) was 2.5 times lower in subjects who had a secondary education and 5 times higher in those with a university education; v) was not correlated with either sex or habitation. We conclude that the breath-actuated inhaler Autohaler allow correct treatment in 82% of poor inhaler technique patients after reading the instruction notice and brief prescriber's explanation, but some patients, elderly or low level of education, must be given clear, detailed and continuing information.

[Tracheal injury caused by intubation for compressive endothoracic goiter]. / Plaie trachéale à l'intubation pour goître endothoracique compressif.

The tube cannot pass along the marked curve of the trachea, which is displaced by a large goiter extending into the posterior mediastinum. The trachea is perforated in a low thoracic location. Tracheal suture and exeresis of the goiter are performed through sternotomia. This serious accident seems to be exceptional. Can it be predicted?