Global initiative against asthma (GINA) guidelines advocates Metered dose inhaler with spacer (MDIs) as the preferred mode for salbutamol aerosol therapy during acute asthmatic exacerbations as compared to use of Nebulizers. However, in practice, Nebulizers continue to be the preferred device for this purpose perhaps due to apprehensions about adequate drug delivery specially in young children and in those with significant respiratory distress. Objectives: To compare the efficacy of aerosolized salbutamol delivery via MDIs versus Nebulizer for the treatment of acute asthmatic exacerbations in children. Methods: In a prospective interventional study, 120 children with acute asthmatic exacerbations wererandomized in two treatment groups- One group received Salbutamol via a jet nebulizer (0.15mg/kg/dose), while another group received it via MDIs (10 puffs below 5 years age, 20 puffs in older children). Inhalations were given at 0, 20 and 40 minutes after enrollment and each case was assessed at 20, 40 and 60 minutes, before next inhalation, for age appropriate response parameters. Results: Cumulative response rate at the end of 60 minutes was comparable in two treatment groups using MDIs and Nebulizer i.e., 88.3% and 80% respectively. However, the response was significantly faster in MDIs group i.e., higher at the end of 40 minutes i.e., 65% versus 43.3% in Nebulizer group (p value 0.027). Mean response time was also significantly lower in MDIsgroup versus nebulizer group (p value 0.02). This Inter group difference in 40-minute response rate and mean response time was significant only in older children above five years of age and not in younger ones. Conclusions: MDIs is at least as effective as nebulizer for salbutamol aerosol therapy in acute asthma with added advantage of faster response, specially in older children.