Paradoxical Bronchoconstriction with Nebulized Albuterol but Not with Terbutaline

A 40-yr-old woman with severe chronic asthma complained that her regular nebulized albuterol was exacerbating her symptoms. Changing to regular nebulized terbutaline resulted in a marked improvement in her peak flow readings. Double-blind challenge with nebulized albuterol and terbutaline confirmed paradoxical bronchoconstriction with albuterol but not with terbutaline. This indicates that paradoxical bronchoconstriction to beta 2-agonists can be specific to the drug preparation used rather than a class effect, as has previously been suggested.