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Arch Pediatr Adolesc Med. 2002;156:626.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

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.

Barton D. Schmitt, MD
Child Health Clinic
The Children's Hospital
1056 E 19th Ave, Box 085
Denver, CO 80218

1. Tien I, Dorfman D, Kastner B, Bauchner H. Metered-dose inhaler: the emergency department orphan. Arch Pediatr Adolesc Med. 2001;155:1335-1339. FREE FULL TEXT

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 . . . [Full Text of this Article]