Comparison of nebulized epinephrine and terbutaline in patients with acute severe asthma: a controlled trial.
OBJECTIVE
To compare the efficacy and tolerability of nebulized adrenaline and terbutaline in acute severe asthma.


METHODS



METHODS
Prospective pilot randomized double-blind cross-over trial.


METHODS
Emergency department of a university hospital.


METHODS
Thirty-eight patients admitted with severe acute asthma. Each patient received adrenaline (3 mg) and terbutaline (5 mg) nebulizations over 20 min in randomized order. Additional treatment comprised methylprednisolone, intravenous hydration, and oxygen. The efficacy and tolerability of the two drugs were evaluated at the end of each nebulization as well as potential synergistic effects.


RESULTS
Eighteen patients received adrenaline first, and 20 received terbutaline first. Peak expiratory flow (PEF) improved significantly in both groups after the first nebulization (from 157 L/min +/- 111 L/min to 199 L/min +/- 134 L/min with adrenaline, P <.01; and from 142 L/min +/- 65 L/min to 193 L/min +/- 181 L/min with terbutaline, P <.01). Both drugs induced a significant decrease in respiratory frequency. The improvement in PaO2 was only significant with terbutaline. Respiratory frequency, PEF and PaO2 were not improved by the second nebulization. No adverse effects were observed.


CONCLUSIONS
Adrenaline nebulization was as effective and as well tolerated as terbutaline in acute severe asthma. No synergistic effect between terbutaline and adrenaline was observed.
Adoun
Michèle
M
Service de Réanimation Médicale Hôspital, Poitiers, France.
Frat
Jean-Pierre
JP
Doré
Pierre
P
Rouffineau
Jean
J
Godet
Cendrine
C
Robert
René
R
D000208:Acute Disease; D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D000336:Aerosols; D001249:Asthma / Q000628:therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010100:Oxygen / Q000097:blood; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D010865:Pilot Projects; D012119:Respiration / Q000187:drug effects; D013726:Terbutaline / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome
D000318:Adrenergic beta-Agonists; D000336:Aerosols; D001993:Bronchodilator Agents; D013726:Terbutaline; D010100:Oxygen; D004837:Epinephrine