Long-term regularly inhaled salbutamol

Seventeen asthmatic patients were allocated at random to one of two treatment regimens: prophylactic (10 patients), in which salbutamol inhaler was used regularly in a dose of 200 micrograms 4-times daily; or symptomatic (7 patients), in which a placebo inhaler was used regularly as 2 actuations 4-times daily. In both regimens, an 'escape' salbutamol inhaler was given to be used for symptomatic relief if and when needed. The study lasted 12 months, after a run-in period of 1 month to accustom patients to the trial procedure. At the end of the year, 16 patients transferred to the alternative regimen for a further 3 months. Both groups were well matched except that the group starting with the prophylactic regimen had more severe airways obstruction than the symptomatic group. Patients were assessed by daily scores of their asthmatic symptoms, twice daily PEFR measurements and the amount of anti-asthmatic medication used. Acute reversibility tests were performed every month at the clinic visits. Patients treated prophylactically had less seasonal variation in PEFR and generally lower symptom scores despite a lower mean PEFR. There was no evidence to suggest tolerance was developing either by acute reversibility tests or by an escalating use of symptomatic salbutamol or other anti-asthma medication. The prophylactic use of salbutamol seemed to provide a more stable control of asthma, offering potential benefit to patients.