In a small study of patients with nighttime asthma, a nonprescription inhaler containing epinephrine was nearly as effective as a prescription inhaler dispensing albuterol in terminating an acute asthma flare-up.

It is widely believed that nonprescription epinephrine inhalers are less effective and have more adverse effects on the heart than prescription drugs like albuterol, Dr. Leslie Hendeles and colleagues write in the Annals of Allergy, Asthma, and Immunology.

The new findings, however, suggest that the two different types of bronchodilator provide similar benefits, although more puffs of the epinephrine inhaler are needed.

The findings are based on a study of eight adults with nocturnal asthma who used first one type of inhaler then the other in crossover fashion. During nighttime asthma flare-ups, the subjects were instructed to administer up to 14 actuations of the assigned agent.

During an attack, lung function fell to about 45 percent of what it should normally be, but treatment with the epinephrine and albuterol inhalers increased function to 86 percent and 93 percent, respectively.

Symptoms fell as lung function improved, and did not return following treatment with either agent.

Typically, 14 puffs of the epinephrine inhaler were needed for the patients to become symptom free, whereas just six actuations of the albuterol inhaler were required.

Contrary to concerns, the extra actuations with epinephrine did not translate into an increase in cardiovascular side effects.

Despite these encouraging results, “a study with a larger number of patients is required before epinephrine can be recommended as rescue therapy,” the team concludes.

SOURCE: Annals of Allergy, Asthma, and Immunology, December 2005.