Paradoxical bronchoconstriction to β-agonists has been reported previously, and has been attributed to hypotonicity or acidity of solution or to preservatives such as benzalkonium chloride. As both solutions studied were isotonic, of like acidity, and preservative- and additive-free, these factors were not likely to be contributing to the results observed. Paradoxical bronchocontriction to β-agonists is not necessarily a class effect, but can attributed to treatment with one specific agent while not observed with other agents in the class.
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