Spacers vs. Nebulizers for Asthma – Which is Better?

East Harlem in NYC is one of the asthma capitals of the nation, so, as you can imagine, I treat lots of asthmatics, big and small. A common question that parents have asked me on discharge is whether they can have a prescription for a nebulizer machine. Many parents feel that nebulizer machines are more effective in the treatment of an asthma attack than a spacer with an MDI (inhaler). My son suffers from asthma so I can see why parents might feel this way. After all, when their child goes to the emergency department, they don’t receive albuterol through an MDI with a spacer – they receive a “neb”. Also, nebulizers are very obvious in their delivery of medication – they are noisy with lots of mist coming out – so clearly, you’re child is getting some sort of treatment.

So, what are the facts?

Spacers with an MDI attached are as equally effective at delivering medication as a nebulizer. Spacers are great to use because not only do they work just as well, but they are portable! Imagine trying to fit a nebulizer machine in your pocket book! Then try to find an electrical outlet!

The issue with using a spacer with an inhaler is that it has to be used properly.
1. Dosage – many parents are taught to give one to two “puffs” of albuterol with their spacer. Studies that have shown that spacers with MDI’s are equally effective to nebulizers use 3-6 puffs. So we are under-dosing when we only recommend 1-2 puffs of an MDI.
2. Proper usage – On the spacer there are instructions on the proper use of a spacer with an MDI. Here is a great link for how to use a spacer with an MDI; How to use an inhaler – with spacer.