OBJECTIVE: To determine the benefit of inhaled high dose budesonide combined with terbutaline in patients with severe asthma at high altitude. METHODS: 42 patients with severe asthma at high altitude were assigned in a randomized, double-blind fashion to receive either budesonide combined with terbutaline (budesonide group, 21 cases) or terbutaline with placebo (control group, 21 cases). Both groups received terbutaline delivered by a metered-dose inhaler in a dose of 2.5 mg. Budesonide delivered by a metered-dose inhaler in 1.2 mg in budesonide group and placebo managed by a specially prepared metered-dose inhaler in control group were administered after terbutaline treatment above procedures. Repeated once after 10 min. Before and after therapy, the scores of the activity of accessory respiratory muscles, dyspnea, wheezing (clinical index) and lung function were documented. RESULTS: At 1, 2, 4, 6 h after therapy, FEV1% [(43 +/- +/- 5)%, (50 +/- 5)%, (57 +/- 5)%, (67 +/- 6)%], PEF% [(47 +/- 5)%, (55 +/- 6)%, (62 +/- 7)%, (69 +/- 7)%], clinical index (5.1 +/- 0.8, 4.3 +/- 0.6, 3.5 +/- 0.6, 2.5 +/- 0.4) in budesonide group and FEV1% [(42 +/- 5)%, (44 +/- 5)%, (45 +/- 5)%, (45 +/- 5)%], PFE% [(46 +/- 5)%, (47 +/- 5)%, (49 +/- 6)%, (49 +/- 6)%], clinical index (5.3 +/- 0.7, 5.0 +/- 0.5, 4.9 +/- 0.7, 4.8 +/- 0.7) in control group were difference markedly compared with before therapy [budesonide group was (35 +/- 5)%, (38 +/- 5)%, 8.3 +/- 1.0, and control group was (33 +/- 5)%, (38 +/- 5)%, 8.3 +/- 1.1, respectively], all (P < 0.01). CONCLUSIONS: High dose of inhaled budesonide combined with terbutaline should be an effective therapy for patients with severe asthma at high altitude. Budesonide inhaled in high dose produces therapeutic effects as soon as 2 h after therapy.