Survey of Albuterol Delivery Methods in Emergency Departments for Acute Asthma Exacerbation in Children 2 Months to 15 Years

The management of pediatric bronchial asthma is often addressed by emergency department (ED) personnel. By surveying emergency program directors, we identify prevailing methods of albuterol delivery for the treatment of an acute asthma exacerbation. Because the Cochrane systematic review reports an equivalent effectiveness of the nebulizer versus metered dose inhaler (MDI) with valved holding chambers (VHC) for albuterol delivery, one might surmise that their usage would be evenly split. However, we find that within an ED setting, use of MDI with VHC sans nebulizer for acute asthma exacerbation is seldom used: 0–1% across all age groups. This is even more surprising considering the nebulizer has been shown to be more expensive than MDI with VHC. It stands to reason the promotion of national guidelines would result in potential cost savings. (Pediatr Asthma Allergy Immunol 2006; 19[3]:180–184).