Objective: 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.
Design: Prospective randomized and double blind study.
Setting: Intensive care unit of a University teaching hospital.
Patients and participants: 22 asthmatic patients presenting to the emergency room with acute severe asthma.
Interventions: 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.
Results: 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.
Conclusion: After a single dose, nebulized adrenaline (2 mg) proved as effective and safe as salbutamol (5 mg) in acute severe asthma.