Patients with chronic obstructive airways disease (COAD) or asthma who have a tracheostomy tube or tracheal stoma have difficulty using metered dose inhalers (MDIs) because of a failure to achieve a good seal between the tracheostomy tube or stoma and the MDI or spacer device mouthpiece. Many such patients therefore utilize nebulizers. MDIs in comparison to nebulizers have the advantages of being more compact, portable, easy to use, less time-consuming, and cheaper. We present the case of a 74-year-old man who underwent a laryngectomy with tracheal stoma formation who had a poor response with nebulizers and required oral steroids. He was subsequently, with the help of a number of attached devices, able to use his MDIs to good effect. We describe a number of devices and adaptors to enable patients with laryngectomy stomas or tracheostomy tubes to utilize MDIs and undergo respiratory function tests. We recommend that all such patients should have the benefit of a consultation with a dedicated respiratory nurse who can provide the appropriate MDIs, devices and adaptors to optimize the treatment of their lower respiratory tract condition.

Foreign bodies in the noses of children may often be expelled by simple nose blowing. Success of this manoeuvre depends on how firmly the object is lodged, and on the co-operation and skill of the child. Attempts at direct removal using instruments frequently result in the patient becoming distressed and resort to general anaesthesia is sometimes required. This short communication describes a series of cases in which nebulized adrenaline helped loosen firmly impacted foreign bodies, thereby facilitating removal, minimizing upset for the child, and avoiding anaesthetic risk.