Mouthpieces and facemasks are being used with nebulizers for delivery of medication in acute asthma. To compare the effectivity of the two devices, 64 children age 6 to 19 years presenting to the hospital with acute asthma were enrolled in a randomized, single-blind study. Group 1 used a facemask. Group 2 used a mouthpiece connected to the nebulizer via short T-shaped tubing. Clinical evaluation and spirometry were performed at baseline and 20, 40, and 60 minutes after a single treatment with albuterol. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and forced expiratory flow over the middle 50% of FVC (FEF25-75) were determined at each point. Adverse effects were recorded. There was no significant difference in improvement between the groups. Patients with nasal congestion, age below 10 years, or severe airway obstruction did equally well with each method. Patients in the facemask group had a higher incidence of tremor. We conclude that the mouthpiece is an effective as the facemask and produces less tremor.