Eight patients with chronic severe asthma, poorly controlled by conventional doses of inhaled bronchodilator, were treated with high-dose inhaled terbutaline (4 mg four times daily), via either wet nebulisation of terbutaline respirator solution, or by tube-spacer aerosol, using cannisters delivering 1 mg terbutaline per metered dose. All patients improved objectively and subjectively on these higher dosage regimens during both day and night. A trial of high-dose inhaled beta2 sympathomimetic therapy should be considered in any patient with chronic severe asthma who fails to obtain benefit from standard doses of inhaled bronchodilator.
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