Terbutaline pressurised aerosol inhaled via a Nebuhaler - An effective alternative to subcutaneous adrenaline for treatment of acute severe asthma

Abstract

The studdy was designed to compare terbutaline inhaled via a 750 ml spacer (Nebuhaler) with subcutaneous adrenaline injection as a first-line treatment for acute severe asthma. Patients were randomly allocated to two treatment groups, receiving either 2 x 4 mg of inhaled terbutaline followed by 2 x 0.5 mg subcutaneous adrenaline (22 patients) or the same drugs in reverse order (24 patients). All patients received a further 2 mg inhaled terbutaline to assess remaining bronchodilator reversibility. Initial treatment with terbutaline produced near maximal bronchodilation (FEV 1 , FVC), whilst initial treatment with adrenaline did not. Terbutaline also reduced symptoms of dyspnoea and wheeze to a greater extent than adrenaline, and was better tolerated with respect to heart rate and side-effects such as tremor. In conclusion, terbutaline inhaled via Nebuhaler was at least as effective as subcutaneous adrenaline, produced fewer side-effects, and hence can be recommended for initial treatment of acute severe asthma.