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Paradoxical bronchoconstriction caused by β2-adrenoceptor agonists.

Khadija Ayed1, Islam Latifa Hadj Khalifa1, Salma Mokaddem1

  • 1Department of Physiology, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis - Tunisia.

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|November 2, 2020
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Summary

Short-acting beta-2 agonists like salbutamol and terbutaline can rarely cause paradoxical bronchoconstriction. This case highlights the importance of physician vigilance for this adverse reaction to bronchodilators.

Keywords:
AsthmaBronchoconstrictionBronchodilatorsSpirometryβ2 adrenergic agonists

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Area of Science:

  • Pulmonology
  • Pharmacology

Background:

  • Salbutamol and terbutaline are common short-acting beta-2 adrenergic agonists used for obstructive pulmonary diseases.
  • Paradoxical bronchoconstriction is a rare but serious adverse reaction to these bronchodilators.

Purpose of the Study:

  • To report a case of paradoxical bronchoconstriction induced by beta-2 adrenergic agonists.

Main Methods:

  • A 50-year-old asthmatic patient with a history of asthma attacks post-inhalation was studied.
  • A 3-day double-blind crossover study compared salbutamol and terbutaline effects.
  • Spirometry (FEV1, FVC, MEF25-75) was used to measure lung function.

Main Results:

  • Terbutaline nebulization confirmed airway obstruction with a 40% decrease in FEV1.
  • Ipratropium bromide did not cause significant changes in spirometric parameters.
  • The patient received a warning regarding salbutamol and terbutaline use.

Conclusions:

  • While generally safe, beta-2 adrenergic agonists can rarely cause paradoxical bronchoconstriction.
  • Physicians should remain vigilant for this side effect and investigate potential cases.