THE EFFECT OF INHALED ALBUTEROL IN MODERATE TO SEVERE ASTHMA

Background: Some recent clinical investigations suggest that regular u se of inhaled bronchodilators may lead to deterioration in asthma cont rol. Objective: The purpose of this study was to evaluate the effect o f albuterol dosing schedule on clinical outcome in subjects with moder ate to severe stable asthma. Methods: Seventeen adults were randomized to two 15-week treatment periods in a double-blind crossover design. Throughout the study, subjects were instructed to take two inhalations four times daily from an unlabeled ''test'' canister. In the four tim es daily and as-needed (QID+PRN) period, this canister contained albut erol; in the as-needed (PRN) period, it contained placebo. A ''rescue' ' albuterol canister was available for as-needed use at all times. Inh aler actuations from both the test and rescue canisters were electroni cally recorded. Outcome measures included prednisone requirements, mor ning and evening symptoms and peak expiratory flow rates, total and ni ghttime rescue albuterol use, and asthma-specific quality of life. Res ults: The two treatment periods did not differ in symptoms, nighttime albuterol use, or asthma quality of life. During the QID+PRN period bo th morning and evening peak expiratory flow rates were significantly h igher (p<0.01 and 0.001, respectively) and total rescue use of albuter ol was significantly less (p<0.05) than the PRN period. Days on predni sone tended to be lower in the regular dosing period (p=0.08). Conclus ion: In our sample of patients with moderate to severe asthma, four ti mes daily dosing of albuterol did not lead to deterioration of asthma control.