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This study, which was designed as a prospective, randomized, double-dummy, parallel-group clinical trial, aimed to compare the use of inhaler and nebulizer delivery systems in bronchodilator treatment in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) from the viewpoints of effectiveness.A total of 43 patients who had moderate to severe acute exacerbations of COPD and required hospitalization were enrolled in this study. The patients were randomized to take either an inhaler bronchodilator drug via an MDI/spacer (Group 1, n=21) as a combination of 1600 mcg salbutamol and 320 mcg ipratropium bromide daily and a nebulised placebo or to take a bronchodilator drug via a nebulizer (Group 2, n=22) as a combination of 10 mg salbutamol and 2 mg ipratropium bromide daily and a placebo via an MDI/spacer. Airway obstruction (peak expiratory flow rate [PEFR]) and gas exchange (arterial partial pressure of oxygen [PaO2] and carbon dioxide [PaCO2], pH and oxygen saturation [SaO2]) were evaluated at 30 min, 6, 24 and 48 hours, and on day 10. Total costs and costs of bronchodilator treatments were calculated in both groups.There were no significant differences between groups at baseline except pH value. In both groups, differences were significant for PEFR, PaO2 and SaO2 (p<0.001), but not for PaCO2 and pH, in comparison with baseline values. Overall, there were no significant differences between groups for all parameters (PEFR, PaO2, PaCO2 and SaO2), while bronchodilator treatments in Group 1 was 6 times as cheap as compared to Group 2 (pcO.OOl]). Total cost was also lower in Group 1 ($250 in Group 1 and $295 in Group 2, p<0.05).The results indicate that treatment cost was lower in Group 1, although both types of treatment had equal effectiveness in the treatment of acute exacerbations of COPD.