Patient preference studies provide important data on the impact of asthma symptoms and the effects of medication on patients' quality of life and functional activity levels. Such studies are lacking in the evaluation of short-acting beta2-agonist treatment for asthma, especially for racemic albuterol. The introduction in 1999 of levalbuterol, the (R)-isomer of racemic albuterol, has provided the opportunity to assess patient preference between racemic albuterol and levalbuterol. Studies with levalbuterol, 1.25 mg, indicated greater bronchodilation than and comparable beta2-mediated side effects to the standard 2.5-mg dose of racemic albuterol, while lower doses of levalbuterol (0.63 mg) provided comparable bronchodilation with reduced beta2-mediated side effects in patients with asthma. This study evaluated treatment satisfaction by the caregivers of children with asthma who currently use and/or have used either levalbuterol (n = 66) or racemic albuterol (n = 76). Twenty-minute-long telephone surveys were administered to caregivers, asking them to rate satisfaction with their child's asthma treatment and provide reasons for satisfaction and dissatisfaction. Significantly more caregivers administering levalbuterol (92%) were "extremely" or "very satisfied" with therapy versus those who currently administered racemic albuterol (51%; p = 0.001). Symptom relief was graded 8.7 (out of 10) for levalbuterol treatment versus 7.5 for racemic albuterol (p = 0.001). Although these differences, in part, may have been influenced by some of the study limitations (e.g., open-label, non-placebo-controlled and nonrandomized design, and potential caregiver recall bias), the statistically significant differences consistently favored levalbuterol and are consistent with results obtained from other clinical studies. The efficacy, dosing flexibility, and improved side effect profile of levalbuterol were the sources of greatest satisfaction for parents/ caregivers in the levalbuterol group. This study supports the conclusion that the majority of caregivers of children with asthma who have experience with both levalbuterol and racemic albuterol prefer levalbuterol over racemic albuterol.