A neb treatment has 2500 mcg of Albuterol, while two puffs of an MDI is 200 mcg of the same medicine. The increase in heart rate often noted with the neb reflects the higher dose. So how do we explain the often reported similar subjective and lung response in patients regardless of delivery method ? I’m not sure, but I wonder if the neb dose could be lowered without sacrificing response for those instances where the MDI is effective. Or approach nebs like we do with an MDI: start with 500 – 1000 mcg, and if desired take a second treatment.