Allergists versus pediatricians: primary choice of metered-dose inhaler with spacer or nebulizer

<b>Background.</b> Many physicians believe delivering medications for asthma exacerbation via nebulizers is more efficacious than using a metered dose inhaler (MDI) with spacer. This study aimed to evaluate pediatricians and allergists' chosen method in children under 5 years: MDI with spacer or nebulizer. <b>Methods.</b> A brief survey was sent via electronic mail to a randomly selected group of pediatricians and allergists. There was a 15.8% (430/2718) total response rate. We divided respondents into 2 groups. Group A comprised 289 primary care pediatricians, and Group B included 141 practicing allergists. <b>Results.</b> In Group A, 68.5% (196/286) respondents indicated an MDI with spacer as their method of choice to deliver bronchodilator therapy during an asthma exacerbation; 64.7% (187/289) reported an MDI with spacer is an effective method; and 48% (135/281) believe delivering medication through a nebulizer will produce increased adverse effects than MDIs with spacers. In Group B, 55% (77/140) of respondents indicated MDI with spacer as their method of choice; 48.9% (69/141) reported a nebulizer is an effective method; and 65.7% (90/137) believe delivering medication through a nebulizer will produce increased adverse effects. <b>Conclusions.</b> Contrary to evidence-based recommendations, most allergists, compared to pediatricians, are not only prescribing nebulizers as their first choice for delivering bronchodilator therapy, but also half of these asthma specialists consider nebulizers to be an effective mode of delivery. As far as safety is concerned, ironically, almost two-thirds of allergists believe more side effects are associated with delivering bronchodilator therapy through a nebulizer.