Nebulizers or pressurized metered-dose inhalers in the treatment of asthma exacerbations

The use of inhaled beta2-agonists delivered by a metered-dose inhaler (MDI) with a holding chamber (spacer) actually is considered the best treatment for childhood acute asthma. However, its use in daily practice still seems rather limited. The aim of this study was to investigate, using a questionnaire, the use of a nebulizer or MDI as the first-line method for delivering inhaled beta2-agonists in children with acute asthma. A questionnaire was developed and distributed to 22 pediatric departments and to 131 family pediatricians (FPs) in northeast Italy. We showed that in the hospitals the episodes of acute asthma usually were treated with bronchodilators administered by wet nebulization (95.45%). This was the case also for FPs (70.9%). However, 29.1% of FPs usually advised the use of an MDI/holding chamber to children with acute asthma. Despite the established efficacy of inhaled beta2-agonists administrated with an MDI compared with wet nebulization in acute asthma, this practice still is rather limited. The use of wet nebulization was more evident in hospital settings compared with community medicine. Emergency room visits may represent a missed opportunity to promote an effective method of delivering bronchodilators in childhood asthma.