The article by Tien et al1 reminds us that delivering albuterol with a metered-dose inhaler with a valved spacer (MDI) for acute asthma attacks has several advantages over using a nebulizer. They carefully document equivalent or improved efficacy, more rapid delivery, and lower cost. I would add that using an MDI in the emergency department (ED) provides an opportunity to reteach the parent how to properly administer bronchodilators by MDI at home. That may eliminate the need for unnecessary return visits to the ED for another "neb bail-out." The good advice in this article also applies to clinic and office treatment of asthma attacks.
Schmitt BD. Preventing Unnecessary Emergency Department Visits for "Albuterol Nebs". Arch Pediatr Adolesc Med. 2002;156(6):626. doi: