long - acting beta-2 agonists such as salmeterol and formoterol are important controller medications in the maintenance therapy of chronic stable asthma , used as an add - on drug to inhaled corticosteroid . however , their usefulness in the management of acute attacks of asthma has recently been recognized , and they are approved for use as reliever medication in europe .
short - acting 2 agonists are the preferred drugs as the initial bronchodilator for acute asthma because of their rapid onset of action . however , due to short duration of action they require frequent administration .
formoterol is a unique bronchodilator having rapid onset and long duration of action with a favorable safety profile .
so it can be an ideal alternative to short - acting 2 agonists in the management of acute asthma exacerbation by providing rapid bronchodilatation and reducing the need for frequent administration .
onset of action of formoterol is similar to salbutamol ( 13 min ) , and 8090% of brochodilatation occurs by 510 min of inhalation .
duration of action is up to 12 h. however , duration of systemic effects with formoterol is found to be as short as salbutamol .
arformoterol ( [ r , r ] formoterol ) is a single isomer form of formoterol , which is available in india recently .
this study compares the efficacy and safety of arformoterol and salbutamol delivered by nebulization in the management of acute non - severe asthma .
a total of 50 patients attending the emergency room or chest opd of a tertiary care hospital with acute non - severe asthma over a 6-month period from january 2010 to june 2010 were selected for this study .
the inclusion criteria were as follows : ( a ) age > 18 years ; ( b ) british thoracic society definition of acute non - severe asthma ; and ( c ) ability to perform forced expiratory maneuver .
the following patients were excluded from the study : ( a ) patients presenting with acute severe / acute life - threatening / near - fatal asthma ; ( b ) patients with a previous diagnosis of chronic obstructive pulmonary disease ( copd ) ; ( c ) history of hypersensitivity to 2 agonists ; and ( d ) pregnant or lactating women .
the study was approved by the institutional ethics committee , and informed consent was obtained from each patient .
the age , sex , duration of asthma symptoms , and present controller medications were recorded .
the pulse rate , respiratory rate , and spo2 ( measured with fingertip pulse oximeter , model 6500 , nidek medical , kolkata , india ) were also recorded at the time of initial assessment .
baseline peak expiratory flow rate ( pefr ) was measured with a peak flow meter ( peak flow master , cipla ltd . ,
patients were then assigned by random number allocation to either of the two groups , that is , salbutamol or arformoterol group according to the medication given to them . in the salbutamol group , 5-mg salbutamol respules were administered through oxygen driven ( 6 l / min ) nebulizer ( pulmo mist ii nebuliser , nidek medical , kolkata , india ) at 20-min intervals for 1 h amounting to a total of 15 mg . in the arformoterol group ,
total 45 g of the drug was administered as 15 g respules every 20 min through the same nebulizer .
the drugs were administered in a double - blind manner . to eliminate the effects of other drugs on the treatment outcome
pefr was also measured 5 min after each dose . at each time , best of the three pefr measurements was recorded .
differences in mean pefr between the two groups were analyzed by unpaired t - test .
one - sample test was used to compare pefr before and after each dose of the drug to determine whether there was significant improvement in either group .
among 50 patients satisfying the inclusion criteria , 25 patients received salbutamol and 25 patients received arformoterol therapy .
baseline characteristics of the patients ( n = 50 ) receiving salbutamol and arformoterol therapy from the table , it is evident that the demographic profile and baseline pefr in the two groups were comparable .
in both the groups , pefr showed significant increase over the baseline values and the increase was evident after each dose of the drug .
the increases in pefr after the first and the second dose were significantly more with arformoterol than with salbutamol , but the increase in pefr after the third dose was similar in these two groups . the comparison of improvement following the therapy with salbutamol and arformoterol is shown in table 2 .
improvement in pefr after each dose of bronchodilator when compared with the baseline both drugs were well tolerated ; no major adverse effect was noted in either group .
as arformoterol is the only long - acting 2 agonist available in india as a nebulizing solution , we have used this drug considering the fact that the clinical pharmacology will be similar with formoterol .
our study has shown that both salbutamol and arformoterol are equally effective as a reliever medication as nebulizing solution in acute non - severe asthma .
improvement in pefr was demonstrated in both the groups and following each dose of the drugs .
the absolute increase in the pefr after the first and the second dose were more with arformoterol than with salbutamol , but the increase in the pefr after the third dose was similar with these two drugs . relatively , hydrophilic drugs such as salbutamol have a rapid onset of action due to their ability to reach the 2 receptor from the aqueous phase .
the aqueous portion rapidly activates the 2 receptor , whereas the lipophilic portion is taken up into the cell membrane from which it diffuses slowly to stimulate 2 receptor over a prolonged period .
several studies have shown the efficacy of formoterol in acute non - severe asthma , acute severe asthma , exercise induced bronchospasm , childhood asthma , and copd.[1317 ] most of the studies have used formoterol with terbuhaler , aerolizer , or metered dose inhaler . however , studies using formoterol nebulization are lacking .
although few studies have shown clinically significant improvement in lung function ( fev1 ) with formoterol when compared with salbutamol , most studies have shown a comparable efficacy .
safety of formoterol is also well documented even at high doses in patients with asthma and copd .
although it is a long - acting drug , systemic effects with formoterol are as short as salbutamol . in few studies , the impact of high - dose formoterol on heart rate , blood pressure , serum potassium , electrocardiogram changes , and arterial blood gas were assessed which showed identical changes comparable with salbutamol
we did not study these parameters but evaluated only the side effects reported by the patients .
the side effects were very few , non - severe , and comparable between these two drugs .
dryness of mouth was the most reported side effect of formoterol inhalation in one study , but we found oral irritation and headache as common side effects .
the sample size is relatively small which limits our ability to detect small but potentially significant differences .
this study is restricted to patients of acute non - severe asthma only ; efficacy and tolerability of arformoterol in other acute settings such as acute severe asthma and acute exacerbation of copd are yet to be explored .
the side effect profile studied by us was only on the basis of the self - reported symptoms of the patients , and objective assessment and laboratory abnormalities were not assessed .
we also did not follow the patients after discharge ; so long - term efficacy and safety were not studied .
further studies are thus needed to clarify the efficacy , actual dose , dose frequency , cost - effectiveness , and long - term safety of arformoterol in acute exacerbations of asthma and copd with different levels of severity .
 arformoterol , a long - acting beta-2 agonist , has a rapid onset and long duration of action . 
 its role as rescue medication in acute asthma attack is undetermined . to compare the efficacy and tolerability of arformoterol with salbutamol nebulization , 
 a study was conducted among 50 patients with acute non - severe asthma . 
 patients were randomly assigned to group 1 ( n = 25 ) and group 2 ( n = 25 ) who received three doses of salbutamol and arformoterol nebulization , respectively , at 20-min intervals . 
 the peak expiratory flow rate ( pefr ) was measured at the baseline and 5 min after each dose . 
 the demographics and baseline characteristics were comparable between the two groups . 
 the mean pefr significantly increased in both these groups when compared with the baseline . 
 the increases in the pefr in two groups were similar after the third dose . 
 the adverse effects in both these groups were minor . 
 arformoterol was as effective and safe as salbutamol in acute non - severe asthma . 
Introduction
Materials and Methods
Results
Discussion