A controlled trial of nebulized salbutamol and adrenaline in acute severe asthma

To compare efficacy and safety of nebulisation of adrenaline (2 mg over 10 min) and salbutamol (5 mg over 10 min) in acute severe asthma.

Prospective randomized and double blind study.

Intensive care unit of a University teaching hospital.

22 asthmatic patients presenting to the emergency room with acute severe asthma.

Patients were randomly assigned to receive either adrenaline (n = 11) or salbutamol (n = 11) via a nebulizer. Additional treatment comprised hydrocortisone hemisuccinate (100 mg) and supplemental oxygen (71/min). The efficacy and safety of both drugs were evaluated at 20 and 40 min.

A statistically significant increase in the Peak Expiratory Flow (PEF) was achieved at the 20th min in both groups (from 85 +/- 38 l/min to 120 +/- 45 l/min; p < 0.001; and from 107 +/- 28 l/min to 145 +/- 19 l/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 statistically significant when compared to the 20 min evaluation. The magnitude 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 increase of PaO2/FIO2 ratio was not significant. The decrease of respiratory frequency at 40 min was more important with salbutamol (p = 0.03). No side effects were recorded in both groups.

After a single dose, nebulized adrenaline (2 mg) proved as effective and safe as salbutamol (5 mg) in acute severe asthma.