Use and Misuse of Albuterol Metered Dose Inhalers

Inhaled metered dose beta₂ aerosols in the patient willing and able to cooperate are a decided advance in therapy, combining a minimum of side effects with a maximum of action. Continuing development of delivery systems may broaden their use to the infirm and uncoordinated patient. Tachyphylaxis is not a serious problem in their ordinary use, but their exact potential to produce tachyphylaxis under conditions of increased use needs more study. Use of inhaled beta₂ aerosols in the patient with "fixed" obstruction of the airways is still of considerable value, and may be reflected more in the total vital capacity than the FEV₁ determination. Combination of the aerosols with a systemic bronchodilator, either theophylline or a beta₂ agonist or their combination, augments the bronchodilation, and in particular, is useful for the patient with severe asthma. However, the severely asthmatic patient, or the patient developing a severe attack, must be adequately coached and managed in the use of corticosteroids since the inflammatory consequences of asthma do not respond significantly to bronchodilators, and the patient may be unaware of the risk of his attack.