Objective: To compare efficacy and safety of nebulisation of adrenalin
e (2 mg over 10 min) and salbutamol (5 mg over 10 min) in acute severe
asthma. Design: Prospective randomized and double blind study. Settin
g: 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 assign
ed 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 1/min to 120 +/- 45 1/min
; p < 0.001; and from 107 +/- 28 1/min to 145 +/- 19 1/min; p < 0.001;
in adrenaline group and salbutamol group respectively). With both dru
gs, PEF further increased at 40 min to a level that was statistically
significant when compared to the 20 min evaluation. The magnitude of t
he absolute variation in PEF was similar with both drugs. Both drugs i
nduced 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 sa
lbutamol (p = 0.03). No side effects were recorded in both groups. Con
clusion: After a single dose, nebulized adrenaline (2 mg) proved as ef
fective and safe as salbutamol (5 mg) in acute severe asthma.