Regular nebulised terbutaline in chronic obstructive airways disease: dose‐response studies fail to detect tolerance.

Abstract

1 To determine the effects of high dose terbutaline on the possible development of tolerance we have examined the influence on dose-response of regular nebulised terbutaline.

A Randomized Controlled Trial To Assess the Optimal Dose and Effect of Nebulized Albuterol in Acute Exacerbations of COPD

“…These results compliment earlier reports of patients with stable COPD in which near-Emax occurred with smaller doses of nebulized terbutaline than those conventionally used over 12 weeks without development of drug tolerance. 10 Fifty percent of Emax during AECOPD in this study was achieved with a cumulative dose of 400 g of inhaled albuterol, and 90% of Emax was achieved with a cumulative dose of 3,200 g. This complements previous studies in which Emax was achieved in stable COPD in the majority at doses of albuterol Ͻ 0.6 mg, 6 and at a dose of 0.8 mg in a smaller cohort of AECOPD patients. 15 The AECOPD dose-response data also add confidence to our conclusions about outcome and may help deflect criticism that the power of the study may not have been adequate to demonstrate small differences.…”

“…The more recent National Institute for Clinical Excellence/BTS evidence-based guidelines 9 could not recommend a specific dose in AECOPD. In stable COPD, earlier studies 10 have shown that 87% of maximal bronchodilation is achieved with an inhaled dose of 2 mg of terbutaline and 97% with a dose of 4 mg. In a larger group of stable COPD patients receiving albuterol, 87% of patients achieved 90% of their maximal bronchodilation (Emax) with doses of inhaled albuterol Յ 1.2 mg. 11 Whether such dose-response effects are applicable in AECOPD is unknown.…”

Tolerance with beta 2‐adrenoceptor agonists: time for reappraisal.

“…Whilst systemic responses were blunted to a significantly greater degree following high dose treatment compared with low dose, there were no differences in the bronchodilator responses. Teale and co-workers [18] studied the bronchodilator responses of a group of 10 patients with severe obstructive airways disease both before and during 3 months treatment with nebulised terbutaline, 5 mg four times daily. Baseline PEFR and FVC improved during the treatment period, and there was no reduction in peak bronchodilator response to cumulative doses of terbutaline.…”