Objectives: To assess the effectiveness of salbutamol delivered via a metered-dose inhaler with spacer versus a nebulizer for acute asthma treatment in the pediatric emergency department.

Methods: All consecutive children younger than 14 years old who required treatment of acute asthma exacerbation in the emergency department during May 2002 (prospective cohort, n = 321) and May 2001(retrospective cohort, n = 259) were included. Inhaled salbutamol was administered by metered-dose inhaler with a spacer (and a face mask in children younger than 2 years old) in the prospective cohort and by nebulizer in the retrospective cohort.

Results: There were no significant differences between the two cohorts in the mean (±SD) age (44.50 ± 38.64 vs. 48.37 ± 43.55 months) and asthma treatment, arterial oxygen saturation (96.34 ± 2.12% vs. 96.19 ± 6.32%), and heart rate (123.71 ± 23.63 vs. 129.41 ± 34.55 beats/min) before emergency department consultation. The number of doses of inhaled bronchodilators was also similar (1.42 ± 1.01 vs. 1.45 ± 0.98) as well as the number of children that required a stay in the observation unit, admission to the hospital, or returned for medical care. The overall mean length of stay in the emergency department was slightly shorter in the prospective cohort (82 ± 48 vs. 89 ± 52 minutes).

Conclusions: The administration of bronchodilators using a metered-dose inhaler with spacer is an effective alternative to nebulizers for the treatment of children with acute asthma exacerbations in the emergency department.