Rationing of medical services will be necessary if we do not develop a more rational and efficient health care system. Respiratory care services are receiving emphasis as we try to curtail spiraling health care costs. In analysis of our respiratory care services, we found that small volume nebulizer (SVN) therapy was still a major portion of our workload. We instituted a protocol to convert to metered dose inhaler (MDI) therapy. All hospitalized patients, excluding those admitted to the spinal cord unit and intensive care units, with a physician's order for aerosol delivery by SVN, were evaluated by respiratory care practitioners for conversion to MDI therapy. A simple protocol for the therapist to use in this conversion was developed. All patients converted to MDI were trained in appropriate MDI use by the therapist. A three-day follow-up of each patient's compliance with proper MDI therapy was initiated. Even with a 72-h allowance for initial SVN treatment, we realized a 9,350 procedure reduction from deleted treatments and an additional 7,650 conversions to MDI. Less than 2 percent of our patients failed to make a completely successful conversion to MDI. Those patients who successfully converted to MDI resulted in reduced hospital costs of $43,758 based on excess medication, supplies, and labor costs associated with SVN treatments. We also saved 5,000 h of technician time that was used to further instruct patients in appropriate MDI therapy. Aerosol therapy by MDI is cost-effective therapy. The institution of guidelines for MDI conversion has reduced fear of failure for both clinicians and patients and illustrates the importance of patient education by qualified respiratory therapists.