Paradoxical Bronchospasm: As with other inhaled beta-adrenergic agonists, AccuNeb can produce paradoxical bronchospasm, which may be life threatening. If paradoxical bronchospasm occurs, AccuNeb should be discontinued immediately and alternative therapy instituted. It should be noted that paradoxical bronchospasm, when associated with inhaled formulations, frequently occurs with the first use of a new canister or vial. Use of Anti-Inflammatory Agents: The use of beta-adrenergic bronchodilators alone may not be adequatetocontrolasthma inmany patients.Earlyconsideration shouldbegiventoadding anti-inflammatory agents (e.g., corticosteroids). Deterioration of Asthma: Asthma may deteriorate acutely over a period of hours or chronically over several days or longer. If the patient needs more doses of AccuNeb than usual, this may be a marker of destabilization of asthma and requires reevaluation of the patient and the treatment regimen , giving special consideration of the possible need for anti-inflammatory treatment (e.g., cortico-steroids). Fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs and with the home use of nebuliz-ers. It is, therefore, essential that the physician instruct the patient in the need for further evaluation, if his/her asthma becomes worse. Cardiovascular Effects: AccuNeb, like other beta-adrenergic agonists, can produce a clinically significant cardiovascular effect in some patients as measured by pulse rate, blo
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