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A comparison of levalbuterol with racemic albuterol in the treatment of acute severe asthma exacerbations in adults.
Am J Emerg Med 2006; 24(3):259-67AJ

Abstract

This multicenter, randomized, double-blind trial compared nebulized levalbuterol (Lev) and racemic albuterol (Rac) in the treatment of acute asthma.

METHODS

Adults with acute asthma exacerbations (FEV(1) 20%-55% predicted) received prednisone and either Lev (1.25 mg, n = 315) or Rac (2.5 mg, n = 312). Nebulized treatments were administered every 20 minutes in the first hour, then every 40 minutes for 3 additional doses, then as necessary for up to 24 hours. The primary end point was time to meet discharge criteria. Secondary end points included changes in lung function and hospitalization rates. A subset of 160 patients had plasma (S)-albuterol concentrations determined at study entry.

RESULTS

Time to meet discharge criteria did not differ between the 2 treatments. FEV(1) improvement was greater following Lev compared with Rac, both after dose 1 and cumulatively over the entire treatment period (dose 1 in intent to treat [ITT] group: Lev 0.50 +/- 0.43 L, Rac 0.43 +/- 0.37 L; P = .02), particularly among the 60% of patients not on recent steroid therapy (dose 1: Lev 0.58 +/- 0.47 L, Rac 0.44 +/- 0.37 L; P < .01), and patients whose entry (S)-albuterol concentrations were in the highest quartile of those measured. A small and similar proportion of Lev-treated (7.0%) and Rac-treated (9.3%) patients required hospitalization (P = .28). Among patients not on steroids, fewer Lev- than Rac-treated patients required admission (3.8% vs 9.3%, P = .03), as was also the case for patients with high plasma (S)-albuterol concentrations. Asthma relapses (5% in 30 days) were lower than in previous reports and did not differ between groups.

CONCLUSIONS

This study suggests that early, regular nebulized beta(2)-agonist and systemic corticosteroid therapy may reduce hospitalization and relapse rates in patients with acute severe asthma. Lev was well tolerated and compared favorably with Rac in improving airway function, particularly in those who were not on inhaled or oral corticosteroids and in those who had high plasma (S)-albuterol concentrations at presentation.

Authors+Show Affiliations

Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16635694

Citation

Nowak, Richard, et al. "A Comparison of Levalbuterol With Racemic Albuterol in the Treatment of Acute Severe Asthma Exacerbations in Adults." The American Journal of Emergency Medicine, vol. 24, no. 3, 2006, pp. 259-67.
Nowak R, Emerman C, Hanrahan JP, et al. A comparison of levalbuterol with racemic albuterol in the treatment of acute severe asthma exacerbations in adults. Am J Emerg Med. 2006;24(3):259-67.
Nowak, R., Emerman, C., Hanrahan, J. P., Parsey, M. V., Hanania, N. A., Claus, R., ... Baumgartner, R. A. (2006). A comparison of levalbuterol with racemic albuterol in the treatment of acute severe asthma exacerbations in adults. The American Journal of Emergency Medicine, 24(3), pp. 259-67.
Nowak R, et al. A Comparison of Levalbuterol With Racemic Albuterol in the Treatment of Acute Severe Asthma Exacerbations in Adults. Am J Emerg Med. 2006;24(3):259-67. PubMed PMID: 16635694.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of levalbuterol with racemic albuterol in the treatment of acute severe asthma exacerbations in adults. AU - Nowak,Richard, AU - Emerman,Charles, AU - Hanrahan,John P, AU - Parsey,Merdad V, AU - Hanania,Nicola A, AU - Claus,Raymond, AU - Schaefer,Kendyl, AU - Baumgartner,Rudolf A, AU - ,, PY - 2005/09/29/received PY - 2005/11/30/revised PY - 2006/01/22/accepted PY - 2006/4/26/pubmed PY - 2006/7/14/medline PY - 2006/4/26/entrez SP - 259 EP - 67 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 24 IS - 3 N2 - UNLABELLED: This multicenter, randomized, double-blind trial compared nebulized levalbuterol (Lev) and racemic albuterol (Rac) in the treatment of acute asthma. METHODS: Adults with acute asthma exacerbations (FEV(1) 20%-55% predicted) received prednisone and either Lev (1.25 mg, n = 315) or Rac (2.5 mg, n = 312). Nebulized treatments were administered every 20 minutes in the first hour, then every 40 minutes for 3 additional doses, then as necessary for up to 24 hours. The primary end point was time to meet discharge criteria. Secondary end points included changes in lung function and hospitalization rates. A subset of 160 patients had plasma (S)-albuterol concentrations determined at study entry. RESULTS: Time to meet discharge criteria did not differ between the 2 treatments. FEV(1) improvement was greater following Lev compared with Rac, both after dose 1 and cumulatively over the entire treatment period (dose 1 in intent to treat [ITT] group: Lev 0.50 +/- 0.43 L, Rac 0.43 +/- 0.37 L; P = .02), particularly among the 60% of patients not on recent steroid therapy (dose 1: Lev 0.58 +/- 0.47 L, Rac 0.44 +/- 0.37 L; P < .01), and patients whose entry (S)-albuterol concentrations were in the highest quartile of those measured. A small and similar proportion of Lev-treated (7.0%) and Rac-treated (9.3%) patients required hospitalization (P = .28). Among patients not on steroids, fewer Lev- than Rac-treated patients required admission (3.8% vs 9.3%, P = .03), as was also the case for patients with high plasma (S)-albuterol concentrations. Asthma relapses (5% in 30 days) were lower than in previous reports and did not differ between groups. CONCLUSIONS: This study suggests that early, regular nebulized beta(2)-agonist and systemic corticosteroid therapy may reduce hospitalization and relapse rates in patients with acute severe asthma. Lev was well tolerated and compared favorably with Rac in improving airway function, particularly in those who were not on inhaled or oral corticosteroids and in those who had high plasma (S)-albuterol concentrations at presentation. SN - 0735-6757 UR - https://www.unboundmedicine.com/medline/citation/16635694/A_comparison_of_levalbuterol_with_racemic_albuterol_in_the_treatment_of_acute_severe_asthma_exacerbations_in_adults_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(06)00044-1 DB - PRIME DP - Unbound Medicine ER -