CORRESPONDENCE * All letters must be typed with double spacing and signed by all authors. * No letter should be more than 400 words. * For letters on scientific subjects we normally reserve our correspondence columns for those relating to issues discussed recently (within six weeks) in the BMJ.
* We do not routinely acknowledge letters. Please send a stamped addressed envelope ifyou would like an acknowledgment. * Because we receive many more letters than we can publish we may shorten those we do print, particularly when we receive several on the same subject.
Eye injuries in racquet sports SIR,-The recent leading article on eye injuries was long overdue. ' It rams home some messages of which, in my own experience, most people who play racquet sports are unaware. Only a few weeks ago I sustained a racquet injury to my left eyeball. As well as an eyelid laceration I sustained corneal bruising 'with associated commotio retinae and subsequent traumatic uveitis. I was extremely fortunate to recover fully with as little' damage. I was certainly luckier than one consultant gynaecologist I know of, who lost an eye as a result of an injury incurred on a squash court. Since my injury I have been amazed at the lack of information or advice on this aspect. A random inquiry in Manchester determined that eye protectors were available in only three of 12 sport shops, the price range being £2-£15. Additionally, only six of 20 opticians stocked any form of eye protectors, the basic price starting at £35 and going up to £70, for which a prescription was necessary. Many countries have made eye protectors mandatory. I wonder whether this would be a prudent step: compulsory seat belt legislation has certainly reduced unnecessary facial injuries as well as mortality. Isn't it worth considering the same principle for squash courts? B A NANAVATI
Longsight Health Centre, Manchester M13 ORR
and most used bronchodilators infrequently. It is not surprising if infrequently used dose regimens are forgotten. We did not ask about changes in the frequency of admission or control of asthma. Nine respondents, however, commented about the loan scheme's value: six said that the scheme had resulted in fewer admissions and three that it had resulted in better control. The fact that most of those who commented thought that avoiding admission was its greatest advantage may explain overuse of bronchodilators. Such parents may have seen admissions overted by the use of extra doses of bronchodilator in the casualty department and may subsequently use the same technique themselves at home. Dr Bendefy suggested that better education might improve the use of home nebulisers. If infrequent use leads to inaccurate recall of doses written instructions may suffice. If, however, parents are copying practices used, for example, in casualty departments this may prove more difficult. It would be interesting to know if those who default from follow up are more likely to exceed recommended doses and if excessive doses are reported on questioning in the consulting room as well as by questionnaire. Regular follow up should provide an opportunity to reinforce messages about correct use provided that parents acknowledge that large doses are used. J M O DONOHOE
1 MacEwen CJ, Jones NP. Eye injuries in racquet sports. BMJ 1991;302:1415-6. (15 June.)
Westminster Children's Hospital, London SW1P 2NS K BURCHETT
London SE14 5ER I Bendefy IM. Home nebulisers in childhood asthma: survey of hospital supervised use. BMJ 1991;302:1180-1. (18 May.)
Home nebulisers SIR,-In 1989 we undertook a postal survey similar to that of Dr Ilona M Bendefy on the use of home nebulisers by children with asthma.' Our findings may address some of Dr Bendefy's concerns. We wrote to the parents of all children to whom the hospital had loaned nebulisers. Replies were received for 19 of 25 children. We asked about the frequency of use of the nebuliser and about admission to hospital since the children had started using the nebuliser. Parents were asked if their child still needed the nebuliser and to comment on the nebuliser service. Five parents said that their children might no longer need the nebuliser. Only one of the children had required admission (once) since starting to use the nebuliser, and all used the nebuliser infrequently (once a month or less). Of the 14 children whose parents thought that they still needed the nebuliser, 13 had either been admitted since getting the nebuliser or used it weekly or more often. Only four of the 19 children used the nebuliser daily, and 12 used it once a month or less. Few of our patients used prophylactic treatment,
BMJ
VOLUME
302
29
JUNE
1991
SIR,-We were interested in Dr Ilona M Bendefy's report on the use of nebulisers in childhood asthma.' We have just completed a survey on the long term effects of home nebulisers in adults with airflow limitation, which showed similar influences on admissions to hospital and a high incidence of side effects. We sent a questionnaire to all patients to whom Leeds Eastern Health Authority's hospital equipment pool had loaned a nebuliser for at least three months to treat asthma and chronic obstructive airways disease. Of 207 patients with a home nebuliser, 167 (8 1%) completed the questionnaire; their mean age was 64 (range 19-85), and they had used a nebuliser for 31 months (3-120 months). Nebulisers were described as very helpful by 119, quite helpful by 35, and little or no help by 13. Side effects were reported by 104, the most common being tremor (80 patients) and palpitations (31). Altogether 126 patients could recall the number of admissions with breathlessness in the 12 months preceding the prescription of a nebuliser and
subsequently. The mean duration of treatment with a nebuliser in this group was 30 months (3-120 months). Since having a nebuliser 105 patients had been admitted less often than before, nine had been admitted more often, and 12 had never been admitted or their frequency of admission was unchanged. The mean number of admissions in a year fell from 2 5 (0-12) to 0 6 (0-7) (paired t test, p
* We do not routinely acknowledge letters. Please send a stamped addressed envelope ifyou would like an acknowledgment. * Because we receive many more letters than we can publish we may shorten those we do print, particularly when we receive several on the same subject.
Eye injuries in racquet sports SIR,-The recent leading article on eye injuries was long overdue. ' It rams home some messages of which, in my own experience, most people who play racquet sports are unaware. Only a few weeks ago I sustained a racquet injury to my left eyeball. As well as an eyelid laceration I sustained corneal bruising 'with associated commotio retinae and subsequent traumatic uveitis. I was extremely fortunate to recover fully with as little' damage. I was certainly luckier than one consultant gynaecologist I know of, who lost an eye as a result of an injury incurred on a squash court. Since my injury I have been amazed at the lack of information or advice on this aspect. A random inquiry in Manchester determined that eye protectors were available in only three of 12 sport shops, the price range being £2-£15. Additionally, only six of 20 opticians stocked any form of eye protectors, the basic price starting at £35 and going up to £70, for which a prescription was necessary. Many countries have made eye protectors mandatory. I wonder whether this would be a prudent step: compulsory seat belt legislation has certainly reduced unnecessary facial injuries as well as mortality. Isn't it worth considering the same principle for squash courts? B A NANAVATI
Longsight Health Centre, Manchester M13 ORR
and most used bronchodilators infrequently. It is not surprising if infrequently used dose regimens are forgotten. We did not ask about changes in the frequency of admission or control of asthma. Nine respondents, however, commented about the loan scheme's value: six said that the scheme had resulted in fewer admissions and three that it had resulted in better control. The fact that most of those who commented thought that avoiding admission was its greatest advantage may explain overuse of bronchodilators. Such parents may have seen admissions overted by the use of extra doses of bronchodilator in the casualty department and may subsequently use the same technique themselves at home. Dr Bendefy suggested that better education might improve the use of home nebulisers. If infrequent use leads to inaccurate recall of doses written instructions may suffice. If, however, parents are copying practices used, for example, in casualty departments this may prove more difficult. It would be interesting to know if those who default from follow up are more likely to exceed recommended doses and if excessive doses are reported on questioning in the consulting room as well as by questionnaire. Regular follow up should provide an opportunity to reinforce messages about correct use provided that parents acknowledge that large doses are used. J M O DONOHOE
1 MacEwen CJ, Jones NP. Eye injuries in racquet sports. BMJ 1991;302:1415-6. (15 June.)
Westminster Children's Hospital, London SW1P 2NS K BURCHETT
London SE14 5ER I Bendefy IM. Home nebulisers in childhood asthma: survey of hospital supervised use. BMJ 1991;302:1180-1. (18 May.)
Home nebulisers SIR,-In 1989 we undertook a postal survey similar to that of Dr Ilona M Bendefy on the use of home nebulisers by children with asthma.' Our findings may address some of Dr Bendefy's concerns. We wrote to the parents of all children to whom the hospital had loaned nebulisers. Replies were received for 19 of 25 children. We asked about the frequency of use of the nebuliser and about admission to hospital since the children had started using the nebuliser. Parents were asked if their child still needed the nebuliser and to comment on the nebuliser service. Five parents said that their children might no longer need the nebuliser. Only one of the children had required admission (once) since starting to use the nebuliser, and all used the nebuliser infrequently (once a month or less). Of the 14 children whose parents thought that they still needed the nebuliser, 13 had either been admitted since getting the nebuliser or used it weekly or more often. Only four of the 19 children used the nebuliser daily, and 12 used it once a month or less. Few of our patients used prophylactic treatment,
BMJ
VOLUME
302
29
JUNE
1991
SIR,-We were interested in Dr Ilona M Bendefy's report on the use of nebulisers in childhood asthma.' We have just completed a survey on the long term effects of home nebulisers in adults with airflow limitation, which showed similar influences on admissions to hospital and a high incidence of side effects. We sent a questionnaire to all patients to whom Leeds Eastern Health Authority's hospital equipment pool had loaned a nebuliser for at least three months to treat asthma and chronic obstructive airways disease. Of 207 patients with a home nebuliser, 167 (8 1%) completed the questionnaire; their mean age was 64 (range 19-85), and they had used a nebuliser for 31 months (3-120 months). Nebulisers were described as very helpful by 119, quite helpful by 35, and little or no help by 13. Side effects were reported by 104, the most common being tremor (80 patients) and palpitations (31). Altogether 126 patients could recall the number of admissions with breathlessness in the 12 months preceding the prescription of a nebuliser and
subsequently. The mean duration of treatment with a nebuliser in this group was 30 months (3-120 months). Since having a nebuliser 105 patients had been admitted less often than before, nine had been admitted more often, and 12 had never been admitted or their frequency of admission was unchanged. The mean number of admissions in a year fell from 2 5 (0-12) to 0 6 (0-7) (paired t test, p
