Date Published

May 18, 2017

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: I have a question about the benefits between using MDI vs. nebulized ventolin. I understand the direction is to use MDI as the preferred route. It certainly makes sense with anybody who is infectious but seems counterintuitive when you could be administering drug with oxygen at the same time as with the case of nebulization. There is also a perceived psychological benefit when patients can feel and see the mist. I have heard about studies that were done at Sick Kids to support MDI use. I was unable to locate them. Is there any other evidence you can suggest as to why MDI is the preferred route? Thank you so much for your time.


Great question. There has been a fair amount of research done comparing MDI vs nebulized Ventolin. The Canadian Pediatric Society provides a good review of asthma and bronchoconstriction in children. In short, the actual amount of drug delivered to the lungs is thought to be greater with MDI delivery, as much of the drug can end up deposited on the face or dispersing away from the patient with nebulized drug delivery. Somewhat paradoxically, in randomized clinical trials there have been no differences between the two methods of drug delivery with respect to oxygenation, respiratory rate, or clinical scores, however, those who receive Ventolin via nebulizer have significantly higher rates of tachycardia, again supporting the MDI route as the preferred method. (Deeronjanawong J, Manuyakorn W, Prapphal N, Harnruthakorn C, Sritippayawan S, Samransamruajkit R. Randomized controlled trial of salbutamol aerosol therapy via metered dose inhaler-spacer vs. jet nebulizer in young children with wheezing. Pediatr Pulmonol 2005;39(5):466-72., Schuh, S., Johnson, D.W., Stephens, D. et al. Comparison of albuterol delivered by a metered dose inhaler with spacer versus a nebulizer in children with mild acute asthma. J Pediatr. 1999;135(1): 22-27.).

Bottom line, you have a device that can deliver the medicine more effectively without increasing the infection exposure risk to yourself or your partner.

Lastly, dont forget that you can administer Ventolin via MDI while still providing supplemental oxygen. If needed, nasal prongs could be used simultaneously with MDI administration.



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