Intensive Care Med (1995) 21:18-23 9 Springer-Verlag 1995 F. Abroug S. Nouira A. Bchir R. Boujdaria S. Elatrous S. Bouchoucha A controlled trial of nebulized salbutamol and adrenaline in acute severe asthma Received: 11 June 1993 Accepted: 4 January 1994 E Abroug (~:~) 9S. Nouira 9A. Bchir R. Boujdaria 9S. Elatrous S. Bouchoucha Service de R~animation Polyvalente, CHU Fattouma Bourguiba, 5019 Monastir, Tunisia Abstract Objective: To compare ef- ficacy and safety of nebulisation of adrenaline (2 mg over 10 min) and salbutamol (5 mg over 10 min) in acute severe asthma. Design: Prospective randomized and double blind study. Setting: Intensive care unit of a University teaching hospital. Patients and participants: 22 asth- matic patients presenting to the emergency room with acute severe asthma. Interventions: Patients were ran- domly assigned to receive either adrenaline (n = 11) or salbutamol (n = l 1) via a nebulizer. Additional treatment comprised hydrocortisone hemisuccinate (100 mg) and supple- mental oxygen (7 l/rain). The effica- cy and safety of both drugs were evaluated at 20 and 40 min. Results: A statistically significant increase in the Peak Expiratory Flow (PEF) was achieved at the 20th min in both groups (from 85_+38 1/min to 120_+45 1/min; p<0.001; and from 107_+28 I/min to 145+ 191/min; p<0.001; in adrenaline group and salbutamol group respectively). With both drugs, PEF further increased at 40 min to a level that was statisti- cally significant when compared to the 20 min evaluation. The magni- tude of the absolute variation in PEF was similar with both drugs. Both drugs induced a significant decrease in heart rate, respiratory frequency and PaCO2 while the in- crease of PaO2/FIO 2 ratio was not significant. The decrease of respira- tory frequency at 40 rain was more important with salbutamol (p = 0.03). No side effects were re- corded in both groups. Conclusion: After a single dose, nebulized adrenaline (2 mg) proved as effective and safe as salbutamol (5 mg) in acute severe asthma. Key words Acute severe asthma 9 Bronchodilators 9 [32 agonists Introduction Nebulized [32 agonists have become the drugs of choice for the primary treatment of acute severe asthma [1- 3]. This has been attributed to the rapid onset of a vigorous bronchodilator effect associated with a large therapeutic index allowing the use of high doses of drugs without side effects [4]. In this instance nebulized salbutamol is the most recommended [32 agonist [3, 5]. Although introduced into the treatment of asthma ear- ly in the century [6], adrenaline was rapidly superseded by selective [32 agonists, particularly because of its a and [31 side effects which are mostly related to the intravenous route of administration [4]. It is now well demonstrated that nebulisation of [32 agonists is more potent and is associated with less side ef- fects than their systemic administration [3, 5]. According- ly, nebulisation of adrenaline might eliminate its adverse effects. Nebulized adrenaline offers potential theoretical