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Diesel fuel and the products of its combustion represent one of the toxins most commonly encountered by people living in both urban and rural areas of the world. As nations become more heavily populated, there will be increasing reliance on diesel fuel to power mass transportation and commercial vehicles, as well as heavy machinery involved in construction, farming, and mining. The majority of patients who present to urban primary care clinics and emergency departments will have had significant chronic exposure to diesel exhaust because most use and/or live near busy streets and highways. Furthermore, those who operate or work or live near diesel-powered machinery will have even more toxic exposure. Primary care physicians should be aware of the acute and chronic deleterious clinical effects of diesel exhaust. In this article we review the toxicity and myriad health problems associated with diesel exhaust.

Objective: To determine if improvement in patients’ metered dose inhaler (MDI) technique could be achieved in the emergency department (ED) with the use of a simple illustrated instruction sheet. Methods: Prospective evaluation of a convenience sample of patients with asthma or COPD. Patients were first subjectively and objectively evaluated on their usual MDI technique, then were given an illustrated instruction sheet to study for 5 minutes. There was no verbal coaching prior to the post-test. A post-test evaluation was then performed. Results were compared using paired Student t test. Results: A total of 115 patients were enrolled. Mean age was 34.9±13.1 years, and mean years using MDI was 5.7±3.8. Subjective improvement in technique was reported by 110 patients (96%) with a mean pre-test score of 7.4±1.5 and post-test score of 9.2±1.1 (p