I would direct your attention to the archives of this list last year. There was an extensive discussion on this topic. Moreover, you might want to specifically read the very insightful comments of our international colleagues, Dr's Peter Barnett and John Chapman.
They have successfully incorporated MDI's for all their asthmatics, with few exceptions. The latter mainly includes the group in a severe exacerbation, with air hunger &/or mental status changes where, the clinical state precludes patient cooperation [ to produce an effective breath.]
Hope that helps.....
Jay Pershad, M.D.
Lebonheur Children's Medical Center
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