Rebound increase in bronchial responsiveness after treatment with inhaled terbutaline

AS Vathenen, BG Higgins, AJ Knox, JR Britton… - The Lancet, 1988 - Elsevier
AS Vathenen, BG Higgins, AJ Knox, JR Britton, AE Tattersfield
The Lancet, 1988Elsevier
To investigate whether cessation of regular β-agonist treatment results in an increase in
bronchial responsiveness, two double-blind, randomised crossover studies were done.
Subjects with mild asthma were investigated to determine the course of change in bronchial
responsiveness, measured as the provocative dose (PD 20) of histamine that caused a 20%
fall in forced expiratory volume in 1 s after short-term and longer term treatment with an
inhaled β-agonist. In the first study in 8 subjects, 500 and 2000 μg terbutaline thrice in 1 day …
Abstract
To investigate whether cessation of regular β-agonist treatment results in an increase in bronchial responsiveness, two double-blind, randomised crossover studies were done. Subjects with mild asthma were investigated to determine the course of change in bronchial responsiveness, measured as the provocative dose (PD20) of histamine that caused a 20% fall in forced expiratory volume in 1 s after short-term and longer term treatment with an inhaled β-agonist. In the first study in 8 subjects, 500 and 2000 μg terbutaline thrice in 1 day protected against histamine-induced bronchoconstriction, and the increase in PD20 compared with placebo remained high throughout the day and overnight. In the second study 8 subjects received placebo or terbutaline 750 μg thrice daily for 14 days. The protection afforded by terbutaline against histamine-induced bronchoconstriction on day 14 was less than that on day 1 by 40% in the morning and 82% in the afternoon. On day 15 PD20 was lower after stopping terbutaline than placebo, with a maximum difference of 1·5 (95% CI 0·6-2·5) doubling-doses of histamine 23 h after the end of treatment. Thus treatment with terbutaline for 1 day did not result in any rebound increase in bronchial responsiveness. Treatment for 2 weeks impaired the ability of terbutaline to protect against histamine-induced bronchoconstriction, and was followed by a rebound increase in bronchial responsiveness after cessation of treatment.
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