Terbutaline inhalations by the turbuhaler® as replacement for domiciliary nebulizer therapy in severe chronic obstructive pulmonary disease

AbstractPatients with chronic obstructive pulmonary disease (COPD) are often treated with high dose inhalations of β2-agonists. We compared domiciliary therapy with terbutaline administered by the Turbuhaler® and by a jet nebulizer. Forty nebulizer users with severe COPD were included in the randomized, double-blind, cross-over study. Terbutaline was inhaled t.i.d. for 2 weeks as dry powder (5 doses=2·5 mg) by Turbuhaler® or as solution (2 ml=5 mg) by jet nebulizer (Pari Inhalierboy®). The mean age of the 25 completing patients was 66 years (range: 54–81), the mean FEV1 was 0·73 l or 29% of predicted (range: 11–55%). The period where the Turbuhaler® delivered the active drug was preferred by 16 patients, the nebulizer period by seven (P=0.09). The median score concerning feeling of control over the disease — according to the Chronic Respiratory Disease Questionnaire — was better after the Turbuhaler® period (P=0·01). Other scores concerning disease related quality of life, the daily peak expiratory flow rates, the additional use of a metered dose inhaler were not significantly different for the two types of treatment. It is concluded that high dose domiciliary terbutaline treatment by Turbuhaler® can replace nebulizer treatment in most patients with severe COPD