Source: Annual Congress 2005 - Bronchodilators with and without corticosteroids
Disease area: Airway diseases

Abstract

Background: Asthmatics taking regular ß-agonists become tolerant to their bronchodilator effects. This is easily shown when bronchodilation is tested during a period of increased bronchomotor tone e.g. after methacholine challenge. Studies thus far have used up to 400μg of salbutamol. In clinical practice much higher doses are used to treat acute asthma. We tested the bronchodilator response to high-dose nebulised salbutamol in asthmatics taking regular formoterol.
Methods: Double-blind, placebo-controlled, crossover study. 11 adult asthmatics were randomised to formoterol 12μg twice daily or placebo for 1 week. 36 hours after the last dose, methacholine challenge was used to produce a 20% fall in FEV₁. Salbutamol 5mg was then given by nebuliser and the FEV₁ was measured over 20 minutes. Subjects then crossed over to the other medication. The main outcome measure was the area under the bronchodilator response curve (AUC). No additional ß-agonists were used throughout the study.
Results: The FEV₁ and PD₂₀ methacholine were not significantly different in the two arms. The response to salbutamol, assessed as AUC, was 18% lower after formoterol compared to placebo (95% confidence interval 0, 36%; p=0.03). The final FEV₁ (20 minutes post-salbutamol) was also lower in the formoterol arm (2.67 vs 2.79L, 95% CI for difference 0.04, 0.20; p=0.05).
Conclusion: The bronchodilator response to salbutamol is reduced in subjects taking formoterol. This tolerance is not overcome by the use of high doses of nebulised salbutamol.
Supported by the Waikato Respiratory Research Fund.

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Citations should be made in the following way:
S. Haney, R. J. Hancox (Hamilton, New Zealand). Tolerance to bronchodilation is not overcome by high dose salbutamol. Eur Respir J 2005; 26: Suppl. 49, 839

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