We examined the inhibitory effect of the long-acting β-adrenergic agonists, mabuterol, clenbuterol and fenoterol on"morning dipping" in ten patients with nocturnal asthma. On the first night, as a control experiment, the subjects received no β-adrenergic agonist. On the succeding three nights at 8:00 PM, each subject was orally administered 50 μg of mabuterol, 40 μg of clenbuterol and 5 mg of fenoterol in a randomized, crossover fashion. Pulmonary function tests(FVC, FEV_<1.0>, PEFR, V_<50> and V_<25>) were performed at 8:00 PM(just before administration of β-adrenergic agonist), 9:00 PM, 10:00 PM, 6:00 AM and 8:00 AM. On the nigh when clenbuterol was administered, there was a significant inhibition of morning dipping at 6:00 AM in FVC(<0.01), FEV_<1.0>(<0.01), PEFR(<0.01), V_<50>(<0.01)and V_<25>(<0.05)compared with the control night. On the nights when mabuterol and fenoterol were administered, there was a significant inhibition of morning dipping at 6:00 AM in FVC(<0.01)and FEV_<1.0>(<0.01)compared with the control night. Palpitations associated with clenbuterol administration were seen in two subjects. The effect of each β-adrenergic agonist varied inconsistently among the subjects. These results indicate that clenbuterol is the most effective in inhibiting morning dipping among the long-acting β-adrenergic agonists examined, but individualization in the choice of β-adrenergic agonist is mandatory in order to achieve the maximum effect.
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