National Jewish Medical and Research Center: "Inhaled Medication with a Metered Dose Inhaler (MDI)."
Asthma Society of Canada: "How to Use Your Inhaler."
Science Daily: "New Asthma Inhaler Propellant Effective, But Costlier."
American College of Chest Physicians: "Using Your MDI-Closed Mouth Technique, Patient Education Guide."
American Academy of Allergy, Asthma & Immunology (AAAAI): "Cumulative effects of formoterol administered by a dry powder inhaler;" "Inhalers;" and "Anti-inflammatory effects of inhaled steroids delivered by HFA-MDI vs delivery by dry powder inhaler."
News release, Merck.
Boehringer Ingelheim: "US FDA Expands Approval of Tiotropium Respimat® for Maintenance Treatment of Asthma in Children."
FDA. Prescribing Information: Spiriva Respimat.
The study, which was published in the academic journal, the European Respiratory Journal , was led by Sarah Brode, PhD, assistant professor of medicine at the University of Toronto, Canada. Using existing data collected on 417,494 people aged 66 and older in Ontario, Canada, Dr. Brode’s team discovered that people who had been prescribed inhaled corticosteroids for the treatment of either asthma or COPD experienced 2,966 cases of nontuberculous myocobacteria (NTB). The association was particularly strong in patients who were using the corticosteroid fluticasone , an ingredient in the allergy medication, Flonase . The risk seemed to be lower for patients using the corticosteroid, budesonide .
Sacks et al. (2005) reported the case of a 72-year-old man, described as professionally successful, intelligent, and cultivated, with polymyalgia rheumatica, who after being treated with prednisone developed a psychosis and dementia , which several behavioral neurology and neuropsychiatry consultants initially diagnosed as early dementia or Alzheimer's disease .  Large dosage variations in the patient's medication (including a self-increased dosage from 10 mg/day to as much as 100 mg/day for at least 3 months) produced extreme behavioral changes, from missed appointments to physical altercations, and eventually admission to a psychiatric ward and later to a locked Alzheimer facility. During this time, neuropsychological testing showed a decline in the patient's previously superior IQ as well as deficits in memory, language, fluency, and visuospatial function, which given the patient's age was considered to be compatible with early dementia. When the steroid treatment ended after a year, the patent's confusion and disorganized appearance stopped immediately. Within several weeks, testing showed strong improvement in almost all cognitive functions. His doctors were surprised at the improvement, since the results were inconsistent with a diagnosis of dementia or Alzheimer's. Testing after 14 months showed a large jump in Full Scale IQ from 87 to 124, but mild dysfunction in executive function, memory, attentional control, and verbal/nonverbal memory remained.