Home nebulizers in severe chronic asthma.

Twenty-four outpatients who continued to have severe chronic asthma despite attending a chest clinic were studied. All were already using inhaled beta-agonists from a pressurized aerosol and regular inhaled corticosteroids. Nineteen were on long-term oral corticosteroids. Comparison was made between their symptoms and peak expiratory flow rate (PEFR) during 4 weeks on their usual treatment and the following month when they were also given 5 mg terbutaline night and morning by nebulizer. During the second month the symptom score for nocturnal asthma improved by 30% (P less than 0.01), for daytime wheeze by 23% (P less than 0.025) and shortness of breath by 15% (P less than 0.01). The prebronchodilator morning and evening PEFR increased by 8% (P less than 0.025) and 10% (P less than 0.01) respectively. A dose-response study with inhaled terbutaline in six patients before and after 4 weeks of nebulizer treatment showed no evidence of a decline in response. Home nebulizers produced considerable overall improvement. Because of variations in individual responses a monitored trial of the type which we have used is desirable before a decision is made on long-term treatment.