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High-dose continuous nebulized levalbuterol for pediatric status asthmaticus: a randomized trial.
J Pediatr. 2009 Aug; 155(2):205-10.e1.JPed

Abstract

OBJECTIVE

To assess the use of high-dose continuous levalbuterol (LEV), the single active (R)-enantiomer of racemic albuterol (RAC), in the treatment of status asthmaticus.

STUDY DESIGN

Children age 6 to 18 years with severe asthma exacerbation were enrolled in this randomized, double-blind trial if they failed initial emergency department (ED) therapy with RAC and systemic steroids. Subjects received equipotent doses of RAC (20 mg/hour) or LEV (10 mg/hour) within a standardized inpatient protocol. Blood samples for measurements of albuterol enantiomer, potassium, and glucose levels were obtained from the first 40 subjects. The median time until discontinuation of continuous therapy was compared using the rank-sum test, and other outcomes were compared using general linear mixed models.

RESULTS

A total of 81 subjects (40 in the RAC group and 41 in the LEV group) were enrolled; the 2 groups were similar at baseline. Both groups tolerated continuous therapy with similar changes in heart rate and serum potassium and glucose levels but higher serum (S)-albuterol concentrations in the subjects treated with RAC. The median time for continuous therapy was similar in the RAC and LEV groups (18.3 hours vs 16.0 hours), as were the other clinical measures.

CONCLUSIONS

Substituting high-dose continuous LEV for RAC did not reduce the time on continuous therapy and had similar adverse effects in children who had failed initial treatment with RAC.

Authors+Show Affiliations

The Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

19464028

Citation

Andrews, Timothy, et al. "High-dose Continuous Nebulized Levalbuterol for Pediatric Status Asthmaticus: a Randomized Trial." The Journal of Pediatrics, vol. 155, no. 2, 2009, pp. 205-10.e1.
Andrews T, McGintee E, Mittal MK, et al. High-dose continuous nebulized levalbuterol for pediatric status asthmaticus: a randomized trial. J Pediatr. 2009;155(2):205-10.e1.
Andrews, T., McGintee, E., Mittal, M. K., Tyler, L., Chew, A., Zhang, X., Pawlowski, N., & Zorc, J. J. (2009). High-dose continuous nebulized levalbuterol for pediatric status asthmaticus: a randomized trial. The Journal of Pediatrics, 155(2), 205-e1. https://doi.org/10.1016/j.jpeds.2009.01.073
Andrews T, et al. High-dose Continuous Nebulized Levalbuterol for Pediatric Status Asthmaticus: a Randomized Trial. J Pediatr. 2009;155(2):205-10.e1. PubMed PMID: 19464028.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-dose continuous nebulized levalbuterol for pediatric status asthmaticus: a randomized trial. AU - Andrews,Timothy, AU - McGintee,Erin, AU - Mittal,Manoj K, AU - Tyler,Lisa, AU - Chew,Amber, AU - Zhang,Xuemei, AU - Pawlowski,Nicholas, AU - Zorc,Joseph J, Y1 - 2009/05/21/ PY - 2008/06/25/received PY - 2008/12/16/revised PY - 2009/01/30/accepted PY - 2009/5/26/entrez PY - 2009/5/26/pubmed PY - 2009/8/21/medline SP - 205 EP - 10.e1 JF - The Journal of pediatrics JO - J. Pediatr. VL - 155 IS - 2 N2 - OBJECTIVE: To assess the use of high-dose continuous levalbuterol (LEV), the single active (R)-enantiomer of racemic albuterol (RAC), in the treatment of status asthmaticus. STUDY DESIGN: Children age 6 to 18 years with severe asthma exacerbation were enrolled in this randomized, double-blind trial if they failed initial emergency department (ED) therapy with RAC and systemic steroids. Subjects received equipotent doses of RAC (20 mg/hour) or LEV (10 mg/hour) within a standardized inpatient protocol. Blood samples for measurements of albuterol enantiomer, potassium, and glucose levels were obtained from the first 40 subjects. The median time until discontinuation of continuous therapy was compared using the rank-sum test, and other outcomes were compared using general linear mixed models. RESULTS: A total of 81 subjects (40 in the RAC group and 41 in the LEV group) were enrolled; the 2 groups were similar at baseline. Both groups tolerated continuous therapy with similar changes in heart rate and serum potassium and glucose levels but higher serum (S)-albuterol concentrations in the subjects treated with RAC. The median time for continuous therapy was similar in the RAC and LEV groups (18.3 hours vs 16.0 hours), as were the other clinical measures. CONCLUSIONS: Substituting high-dose continuous LEV for RAC did not reduce the time on continuous therapy and had similar adverse effects in children who had failed initial treatment with RAC. SN - 1097-6833 UR - https://www.unboundmedicine.com/medline/citation/19464028/High_dose_continuous_nebulized_levalbuterol_for_pediatric_status_asthmaticus:_a_randomized_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3476(09)00113-9 DB - PRIME DP - Unbound Medicine ER -