Comparison of nebulized epinephrine and terbutaline in patients with acute severe asthma: a controlled trial

Abstract

Purpose: To compare the efficacy and tolerability of nebulized adrenaline and terbutaline in acute severe asthma. Methods: Design: Prospective pilot randomized double-blind cross-over trial. Setting: Emergency department of a university hospital. Patients: 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.