Background: Although albuterol remains the standard treatment for asthma in the emergency department, formoterol fumarate may be more advantageous, with its rapid and long-lasting bronchodilation. Objective: To compare formoterol fumarate with albuterol in controlling acute asthma exacerbation. Methods: Patients aged 18 to 65 years who presented to the emergency department with mild to moderate asthma exacerbation (peak expiratory flow rate [PEFR], 40%-60% of predicted) were randomized to receive either formoterol fumarate aerolizer (12 μg) or albuterol nebulizer (2.5 mg) every 30 minutes up to 2 treatments. Symptom scores and PEFRs were measured at each treatment. Results: Thirty-four patients (19 in the albuterol arm and 15 in the formoterol fumarate arm) were enrolled. At 30 and 60 minutes, the mean PEFR of the albuterol group increased from 43.7% of predicted to 51.9% of predicted and 54.6% of predicted, respectively, and the formoterol fumarate group had changes in the mean PEFR from 49.3% of predicted to 55.5% of predicted and 57.3% of predicted, respectively, and the mean change in the 2 groups was not significantly different at 30 and 60 minutes (P = .64 and .57, respectively, by t test). The albuterol group improved in symptom scores by 3.7 and 5.5 from 0 minutes to 30 and 60 minutes, respectively, and in the formoterol fumarate group these values were 3.1 and 4.9 at 30 and 60 minutes, respectively, and the mean change in the 2 groups was not significantly different at 30 and 60 minutes (P = .61 and .76, respectively, by t test). Conclusion: Formoterol fumarate is as effective as albuterol inhalation for the treatment of adults with mild to moderate asthma exacerbations in the acute care setting.