ABSTRACT
Finally, the majority of reported studies painstakingly describe the administration method for the MDI plus spacer including the coaching of patients to take slow, deep breaths but often omitted similar detail concerning the nebulizer except to suggest the patients took it by tidal breathing with a mask or mouthpiece. Thus, the studies may be biased in that every effort was made to optimize delivery from the MDI plus spacer but not from the nebulizer (i.e., volume fill, nebulizer flow, use of thumb valve to decrease loss during exhalation, attention to inhalation technique, and using the most efficient nebulizer) (72). The overall impression from the studies is that similar results can be obtained from an MDI plus spacer and nebulizer in the emergency department provided that trained personnel, either nurses or respiratory therapists, assist the patient in administration of the drug. Thus, the difference in cost must derive primarily from the difference in cost between the drug, nebulizer, and spacer devices.
