In Reply.—Dr Plaut describes a pattern of use that places him in accord with the majority of the other experts I interviewed.
The efficacy and safety of using nebulized sympathomimetic bronchodilators at home have been addressed recently. In an inner-city pediatric population Zimo et al1 found that emergency department visits and hospital admissions were significantly reduced after the institution of home nebulizers, especially for younger children. Their use was not associated with increased respiratory failure or other morbidity, despite probable divergence between the instructions and the actual use.
Although the use of inhaled bronchodilators obliges the physician to train parents and children in the techniques of their use and, as Dr Plaut correctly emphasizes, in monitoring the effectiveness of such treatment, the results seem to justify the effort. I am dismayed by the widespread neglect of elementary monitoring, even in children admitted to the hospital for acute, severe