Nebulizers versus pressurized metered-dose inhalers in preschool children with wheezing.

QUESTION In my office, I frequently encounter children with wheezing. When I prescribe inhaled bronchodilators for preschool children, what is the recommended method of delivery--a nebulizer or a spacer? ANSWER The pressurized metered-dose inhaler with a spacer is an effective method of delivering inhaled drugs to young children. Children younger than 5 years of age will require the additional use of a face mask. It is best to give aerosolized medications when a child is awake. Efforts to optimize the child's cooperation with medication administration by using a spacer with an appropriate mouthpiece or face mask will also improve drug delivery.