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July 7, 1978

Diminishing Response to Ephedrine

Author Affiliations

La Rabida Children's Hospital and Research Center University of Chicago Pritzker School of Medicine Chicago

JAMA. 1978;240(1):20-21. doi:10.1001/jama.1978.03290010024005

To the Editor.—  Several authors have recently reevaluated the use of ephedrine sulfate for asthma in adults1,2 and children.3-5 Its bronchodilating effects have generally been confirmed, and no tachyphylaxis has been found. This has been in contrast to the loss of effect reported by Herxheimer6 in patients taking the drug for only a few days. We have observed an instance of asthma consistently worsening after first responding to ephedrine therapy.

Report of a Case.—  A 12-year-old boy was referred to La Rabida Children's Hospital for treatment of asthma that had been poorly controlled since its onset at 4 years of age. Initial assessment showed severe obstructive lung disease. After oral aminophylline was given to maintain serum theophylline levels at 15 to 20 μg/ml, considerable improvement occurred, but pulmonary function testing continued to show moderate obstruction, not completely reversed by subcutaneous epinephrine or inhaled isoproterenol. His peak expiratory