To determine whether parents who deliver albuterol treatments in a pediatric emergency department with a metered dose inhaler with a spacer device (MDIS) report better adherence to MDIS use at home compared to parents whose children undergo standard nebulizer therapy. Children aged 1-5 years were randomized by day to usual treatment with nebulized albuterol (40 children) or to treatment by the parent with albuterol with an MDIS (46 children). All caregivers received standard discharge instructions, a spacer and an MDI. Two weeks following the visit, a trained research assistant blinded to the child's group status, administered a brief telephone questionnaire to each caretaker. At follow-up, children in the MDIS group were 7.5 times more likely to be using the MDIS for their albuterol treatments (95%CI 1.6-35.6). Involving parents in treatment of asthma exacerbations in the emergency department using an MDIS may improve adherence to MDIS use at home.