We thank Dr Schmitt for his comments and certainly agree that the use of MDIs for acute asthma attacks in the ED would present an opportunity to educate parents and patients about the proper use. It also would allow for reinforcement of the benefits of MDI use at home, including improved portability, lower cost, and reductions in the total time required to administer treatment. There continue to be, however, barriers to translating this knowledge into a change in physician behavior. As we have previously described, medical decisions in which the physician has more discretion are often greatly influenced by the physician's perception of patient preference.1 This study demonstrated that 24% of pediatric ED physicians are under the impression that patients and parents prefer nebulizers over MDIs when they come to the ED for acute asthma. However, in studies comparing patient and parent satisfaction with MDIs vs nebulizers for the treatment of acute asthma in the ED, MDIs were preferred.2,3 Until the medical community embraces the benefits of MDI use for acute asthma in children, parents will continue to receive inconsistent messages about their use in the home.
Tien I, Bauchner H. Preventing Unnecessary Emergency Department Visits for "Albuterol Nebs". Arch Pediatr Adolesc Med. 2002;156(6):626. doi: