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Robert W. Hickey, MD
Department of Pediatrics Columbus Children's Hospital 700 Children's Dr Columbus, OH 43205-2696

Robert F. Gochman, MD
New Hyde Park, NY

Vidya Chande, MD; Holly W. Davis, MD
Pittsburgh, Pa

Arch Pediatr Adolesc Med. 1994;148(12):1353-1354.

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

We thank Dr Carter for his interest in our study and appreciate his comments. Dr Carter believes that the use of an MDI-S for administration of medications to infants and toddlers is controversial. We disagree; there are six published studies demonstrating effective administration of bronchodilators to infants via MDI-S.^1-6

Dr Carter objects to our spacer's small volume and the presence of a one-way valve. Larger-volume spacers have less drug impacted on the wall of the spacer with actuation, thereby increasing drug availability. A smaller-volume spacer will have less total drug available owing to impaction, but the concentration of drug in the spacer will be greater. In patients with small tidal volumes, the benefit of increased drug concentration found in smaller-volume spacers becomes relatively more important than the amount of total drug available in larger spacers.⁷ In other words, although there may be more drug available in . . . [Full Text PDF of this Article]

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