To the Editor.—
I agree with Reisman (211:1782, 1970) that in some instances use of an isoproterenol (Isuprel) nebulizer may increase the severity of asthma. The blame for misuse does not lie with the patient who is desperately trying to stay alive.Isoproterenol is effective only when applied directly to the bronchial mucosa. Many patients spray the medication in their mouths and thereby derive little or no benefit, only irritating their throats and vocal cords. A few moments of instruction to exhale forcibly before taking a single inhalation are well worth the time and trouble.Patients are all too frequently told to use the nebulizer only when absolutely necessary. Postponing use until obstruction is so severe as to make penetration into the bronchi impossible tends to set up a vicious circle of further inhalations and irritation as pointed out by Dr. Reisman. Early use at the first premonition of
Robbins JJ. Hand Nebulizers in Asthma. JAMA. 1970;213(5):873. doi:10.1001/jama.1970.03170310151058
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