title: Metered-dose inhaler: the emergency department orphan.
abstract: OBJECTIVE
  Physicians providing emergency department care to children primarily use nebulizers for the delivery of bronchodilators and these physicians have misconceptions regarding the advantages and disadvantages of using metered-dose inhalers (MDIs) with a spacer (MDI + S) for acute asthma exacerbations.
  
  
  METHODS
  Self-administered mail survey.
  
  
  METHODS
  Emergency department.
  
  
  METHODS
  Emergency medicine section members of the American Academy of Pediatrics and Canadian Pediatric Society.
  
  
  METHODS
  Bronchodilator delivery methods in acute pediatric asthma.
  
  
  METHODS
  The 2 principal outcomes for bivariate analysis were self-reported nebulizer use in all patients and MDI + S use in patients with mild acute asthma.
  
  
  RESULTS
  Of eligible physicians, 333 (51%) of 567 responded. The majority were dual trained in pediatrics and pediatric emergency medicine (72%) and practiced full time (83%) in an urban (83%) pediatric emergency department (80%). The most commonly cited advantages of MDIs were their cost (33%) and speed of use (28%). The most commonly cited disadvantages were patient or parent dissatisfaction (24%) and relative ease of nebulizer use (23%). Only 10% to 21% of participants used MDIs in the emergency department and reserved this delivery method for children with mild asthma exacerbations. There were no significant associations between selected respondent demographic variables and the use of MDIs.
  
  
  CONCLUSIONS
  Misconceptions regarding the efficacy and safety of MDI + S for the treatment of acute asthma exacerbations exist but are limited to a minority of surveyed emergency medicine physicians caring for children. Nebulizers remain the preferred method of routine bronchodilator delivery by physicians providing care to pediatric asthmatics in the emergency department.
authors.affiliation: Division of Pediatric Emergency Medicine, Boston Medical Center and Boston University School of Medicine, MA 02118, USA. irene.tien@bmc.org
authors.forename: I
authors.initials: I
authors.lastname: Tien
authors.forename: D
authors.initials: D
authors.lastname: Dorfman
authors.forename: B
authors.initials: B
authors.lastname: Kastner
authors.forename: H
authors.initials: H
authors.lastname: Bauchner
mesh_terms: D000208:Acute Disease; D001249:Asthma / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002983:Clinical Competence; D004636:Emergency Service, Hospital; D019538:Health Care Surveys; D006801:Humans; D009330:Nebulizers and Vaporizers; D010372:Pediatrics; D010818:Practice Patterns, Physicians'
chemical_list: D001993:Bronchodilator Agents