Objective: To compare the efficacy of metered dose inhaler with spacer with dry powder inhaler for delivery of salbutamol in acute exacerbation of bronchial asthma Design: Randomized controlled trial in the Setting of Department of Pediatrics, Patna Medical College and Hospital Patna Methods: Children in the age group of 5 - 12 years who presented with a mild or moderate acute exacerbation of asthma were randomized to receive 400 mcg salbutamol by either a MDI with spacer or a DPI. The changes in the wheezing and accessory muscle scores, SaO2, and PEFR were recorded and subjected to statistical tests for significance. Results: Two hundred and fifty-three children were studied; 128 were assigned to the MDIspacer group and 125 to rotahaler (DPI) group. After receiving treatment, the PEFR improved by about 11% in both the groups. The oxygen saturation increased by 2% in both the groups. Within each group, the improvement in PETR, SaO2, wheeze and accessory muscle score after the treatment was statistically significant. Conclusion: Metered dose inhaler with spacer and dry powder inhaler are equally effective in delivering salbutamol in therapy of mild to moderate acute exacerbations of bronchial asthma in children between 5-12 years of age.