Abstract
Like fenoterol, salbutamol reduces the sensitivity of asthmatic airways to acute contractile stimuli, but can increase sensitivity in some subjects following regular administration,1 a finding which has inevitably questioned the use of regular inhalation of β2-agonists in asthma.2 Such increased sensitivity is paradoxical, since it cannot be attributed to the R-enantiomer which is a bronchodilator and reduces airway sensitivity. However, it could reflect actions of the S-enantimer, which is not a bronchodilator, which can increase sensitivity of asthmatic airways,3 and which accumulates disproportionately because of stereospecific metabolism.
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