Paradoxical bronchoconstriction caused by β 2 -adrenoceptor agonists

Salbutamol and terbutaline are short-acting β adrenergic agonists that produce bronchial smooth muscle relaxation and are widely used in obstructive pulmonary diseases. Nevertheless, their use has been the cause of a paradoxical bronchoconstriction, which is a rare and potentially serious adverse re...

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Bibliographic Details
Published inDrug target insights Vol. 14; p. 12
Main Authors Ayed, Khadija, Khalifa, Islam Latifa Hadj, Mokaddem, Salma, Jameleddine, Saloua Ben Khamsa
Format Journal Article
LanguageEnglish
Published Italy 2020
Subjects
Spirometry
Bronchoconstriction
Bronchodilators
Asthma
β2 adrenergic agonists
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Summary:Salbutamol and terbutaline are short-acting β adrenergic agonists that produce bronchial smooth muscle relaxation and are widely used in obstructive pulmonary diseases. Nevertheless, their use has been the cause of a paradoxical bronchoconstriction, which is a rare and potentially serious adverse reaction. The aim of this study is to report a case of paradoxical bronchoconstriction caused by β adrenergic agonists. This case is about a 50-year-old asthmatic patient who describes a history of repeated acute asthma attacks after salbutamol inhalation or terbutaline nebulization. A double-blind crossover study was performed over 3 days, in order to compare the effects of each bronchodilator. Forced expiratory volume in 1 second (FEV ), forced vital capacity (FVC), and maximal expiratory flow 25-75 (MEF25-75) were measured. On the first day, a bronchoconstriction caused by deep and repeated inhalations was eliminated. On the second day, an airway obstruction was confirmed by a decrease in FEV at 40% from baseline values after nebulization of a standard dose of terbutaline. On the third day, a spirometry was performed before and after nebulization of a standard dose of ipratropium bromide, and there were no significant changes in the spirometric parameters. Finally the patient was discharged with a written warning mentioning the danger of salbutamol and terbutaline use. Salbutamol and terbutaline are generally well-tolerated β adrenergic agonists. Nevertheless, in rare cases, these substances can cause a paradoxical bronchoconstriction. Doctors must therefore remain vigilant about its side effect and possibly investigate each case.
ISSN:1177-3928
1177-3928