Caveats: The two RCTs, even when combined, are small and concrete conclusions would be premature, thus these data, while they represent the best currently available evidence, should be considered preliminary. In addition both studies were undertaken during the early and mid-1980’s and it is possible that when combined with more advanced supportive care modalities, or lung protective strategies, the intervention may be more effective. In addition, the trials studied different patient populations with one (Bernard 1987) examining patients with ARDS and the other (Weigelt 1985) examining patients with ALI. There was also significant heterogeneity between the two studies (I 2 = %).
A Cochrane review found that those treated with continuously nebulized bronchodilators had lower rates of hospitalization, greater improvements in pulmonary function test results, and similar rates of adverse events compared with those treated intermittently. Continuous treatment allows greater compliance with the goal of delivering the equivalent of three intermittent bronchodilator treatments in the first hour of care. In addition, this method will result in less respiratory therapy time and costs; it has been shown to be safe, and it may benefit the sickest patients the most.
In addition to the mentioned side effects several others have been reported. In both males and females acne are frequently reported, as well as hypertrophy of sebaceous glands, increased tallow excretion, hair loss, and alopecia. There is some evidence that anabolic steroid abuse may affect the immune system, leading to a decreased effectiveness of the defense system. Steroid use decreases the glucose tolerance, while there is an increase in insulin resistance. These changes mimic Type II diabetes. These changes seem to be reversible after abstention from the drugs.