The subject of whether a spacer is as good as a nebuliser in an acute attack seems to have come up several times recently. I thought folks might be interested in the actual wording of the BTS guidelines:
""5.2 BETA-2 AGONIST THERAPY
5.2.1 Acute asthma
pMDI and spacer is at least as good as a nebulizer at treating mild and moderate exacerbations of asthma in children and adults.
Children and adults with mild and moderate exacerbations of asthma should be treated by pMDI and spacer with doses titrated according to clinical response.
There are no data to make recommendations in severe (life-threatening) asthma.""
So this advice was never meant to apply to severe exacerbations. I think some of the problem might be that some doctors are generalising it to severe attacks.
From personal experience, I agree with what seems to be the majority opinion on here - an MDI and spacer just doesn't do the job as well as a neb! Apart from anything else, in a severe attack I find I often can't generate enough air flow to shift the valve on the Volumatic, especially as they seem to have a tendency to stick!
Like so many things in severe and brittle asthma, it seems to be a case of 'what works for you' since there aren't any trials!
Take care all