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

The study 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 (FEV1, 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.