Severe acute asthma: a comparison of three methods of inhaling salbutamol

The effects of salbutamol inhaled by three different methods were compared in groups of adult patients with severe acute asthma. 2 x 400 micrograms Rotacaps was the optimum dose of dry powder but about 40% of patients failed to respond to it. 5 mg salbutamol nebulized with IPPB resulted in a significant increase in peak expiratory flow rate when given before or after either Rotacaps or salbutamol nebulized without IPPB, whereas neither the dry powder nor the nebulized drug without IPPB resulted in significant change when given after salbutamol nebulized with IPPB. The extra benefit derived with IPPB is only slight and requires a device of appropriate characteristics. Occasional patients fail to respond to salbutamol inhaled by any means, generally those with the most severe airflow limitation.