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An evaluation of nebulized levalbuterol in stable COPD.
Chest 2003; 124(3):844-9Chest

Abstract

BACKGROUND

Levalbuterol, the R-isomer of albuterol, has advantages over racemic albuterol in asthma; however, the effectiveness of this beta-agonist in COPD has received little attention.

OBJECTIVES

To evaluate the effectiveness of a single dose of nebulized levalbuterol in COPD.

DESIGN

A randomized, double-blind, placebo-controlled trial comparing nebulized levalbuterol to racemic albuterol, combined racemic albuterol and ipratropium, and placebo.

PATIENTS

Thirty patients with stable COPD (FEV(1) between 45% and 70% of predicted) were studied.

METHODS

After withholding usual bronchodilator medications for appropriate washout periods, patients were randomized on separate visits to receive single doses of each the following nebulized bronchodilator medications: (1) levalbuterol, 1.25 mg; (2) racemic albuterol, 2.5 mg; (3) combined racemic albuterol, 2.5 mg, and ipratropium, 0.5 mg; or (4) placebo. FEV(1), FVC, pulse rate, and oxygen saturation were measured at baseline, 0.5 h following nebulization, and hourly for 6 h. Hand tremor, using a 7-point scale, was measured at baseline, 0.5 h, 1 h, and 2 h. Treatment-placebo differences were analyzed using repeated-measures analysis of variance and least-squares means.

RESULTS

The mean age (+/- SD) of patients was 69 +/- 15 years. Mean FEV(1) was 1.15 +/- 0.49 L. By 0.5 h following study drug administration, all three nebulized bronchodilator treatments led to similar, significant improvements in FEV(1) compared to placebo. These effects persisted at 1 h and 2 h for all three treatments; however, by 3 h, only the combined albuterol/ipratropium group had a mean change in FEV(1) significantly greater than placebo. There were no significant differences between bronchodilator groups at any time period. A mild increase in pulse rate was observed in all treatment groups. There were no significant treatment-placebo differences in oxygen saturation or hand tremor.

CONCLUSION

For single-dose, as-needed use in COPD, there appears to be no advantage in using levalbuterol over conventional nebulized bronchodilators.

Authors+Show Affiliations

Section of Pulmonary and Critical Care Medicine, St. Francis Hospital & Medical Center, 114 Woodland Street, Hartford, CT 06105, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

12970007

Citation

Datta, Debapriya, et al. "An Evaluation of Nebulized Levalbuterol in Stable COPD." Chest, vol. 124, no. 3, 2003, pp. 844-9.
Datta D, Vitale A, Lahiri B, et al. An evaluation of nebulized levalbuterol in stable COPD. Chest. 2003;124(3):844-9.
Datta, D., Vitale, A., Lahiri, B., & ZuWallack, R. (2003). An evaluation of nebulized levalbuterol in stable COPD. Chest, 124(3), pp. 844-9.
Datta D, et al. An Evaluation of Nebulized Levalbuterol in Stable COPD. Chest. 2003;124(3):844-9. PubMed PMID: 12970007.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An evaluation of nebulized levalbuterol in stable COPD. AU - Datta,Debapriya, AU - Vitale,Anthony, AU - Lahiri,Bimalin, AU - ZuWallack,Richard, PY - 2003/9/13/pubmed PY - 2003/10/16/medline PY - 2003/9/13/entrez SP - 844 EP - 9 JF - Chest JO - Chest VL - 124 IS - 3 N2 - BACKGROUND: Levalbuterol, the R-isomer of albuterol, has advantages over racemic albuterol in asthma; however, the effectiveness of this beta-agonist in COPD has received little attention. OBJECTIVES: To evaluate the effectiveness of a single dose of nebulized levalbuterol in COPD. DESIGN: A randomized, double-blind, placebo-controlled trial comparing nebulized levalbuterol to racemic albuterol, combined racemic albuterol and ipratropium, and placebo. PATIENTS: Thirty patients with stable COPD (FEV(1) between 45% and 70% of predicted) were studied. METHODS: After withholding usual bronchodilator medications for appropriate washout periods, patients were randomized on separate visits to receive single doses of each the following nebulized bronchodilator medications: (1) levalbuterol, 1.25 mg; (2) racemic albuterol, 2.5 mg; (3) combined racemic albuterol, 2.5 mg, and ipratropium, 0.5 mg; or (4) placebo. FEV(1), FVC, pulse rate, and oxygen saturation were measured at baseline, 0.5 h following nebulization, and hourly for 6 h. Hand tremor, using a 7-point scale, was measured at baseline, 0.5 h, 1 h, and 2 h. Treatment-placebo differences were analyzed using repeated-measures analysis of variance and least-squares means. RESULTS: The mean age (+/- SD) of patients was 69 +/- 15 years. Mean FEV(1) was 1.15 +/- 0.49 L. By 0.5 h following study drug administration, all three nebulized bronchodilator treatments led to similar, significant improvements in FEV(1) compared to placebo. These effects persisted at 1 h and 2 h for all three treatments; however, by 3 h, only the combined albuterol/ipratropium group had a mean change in FEV(1) significantly greater than placebo. There were no significant differences between bronchodilator groups at any time period. A mild increase in pulse rate was observed in all treatment groups. There were no significant treatment-placebo differences in oxygen saturation or hand tremor. CONCLUSION: For single-dose, as-needed use in COPD, there appears to be no advantage in using levalbuterol over conventional nebulized bronchodilators. SN - 0012-3692 UR - https://www.unboundmedicine.com/medline/citation/12970007/An_evaluation_of_nebulized_levalbuterol_in_stable_COPD_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(15)37638-8 DB - PRIME DP - Unbound Medicine ER -