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Efficacy of racemic albuterol versus levalbuterol used as a continuous nebulization for the treatment of acute asthma exacerbations: a randomized, double-blind, clinical trial.
J Asthma. 2011 Mar; 48(2):188-93.JA

Abstract

OBJECTIVE

To compare racemic albuterol (RAC) with levalbuterol (LEV) in continuous form for the treatment of acute pediatric asthma exacerbations in the emergency department.

STUDY DESIGN

Children between the ages of 6 and 17 inclusive were enrolled if they had a history of asthma, presented to the emergency department with an acute asthma exacerbation, and had an initial forced expiratory volume in 1 second (FEV1) <70% predicted. Patients were then randomized to receive either 7.5 mg of RAC or 3.75 mg of LEV over 1 hour, in addition to standard asthma therapies. Spirometry and asthma scoring were performed at the end of the first hour, and a second hour-long nebulization with the same drug was administered if deemed necessary. Spirometry and asthma scoring were again performed and the final disposition was recorded. As a second, optional part of the study, baseline serum albuterol levels were collected on some patients before treatment.

RESULTS

A total of 99 patients completed the study (44 RAC and 55 LEV). Baseline characteristics were similar except that the RAC group had a higher baseline asthma score. Children in the RAC group had a greater improvement in their FEV1 (p = .043) as well as in their asthma scores (p = .01) after 1 hour of continuous treatment compared to the LEV group. The greater improvement in asthma scores was maintained after the second hour of continuous therapy in the RAC group (p = .008) but not for FEV1 measurements (p = .57). There were no differences between groups for changes in heart rate, respiratory rate, oxygen saturation, or rates of admission.

CONCLUSIONS

At the doses used, RAC appears to be superior to LEV with respect to changes in FEV1 and asthma score. There was no significant difference between the drugs with respect to admission rates or side-effect profile.

Authors+Show Affiliations

Department of Emergency Medicine, Dell Children's Medical Center of Central Texas, Austin, TX, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

21275850

Citation

Wilkinson, Matthew, et al. "Efficacy of Racemic Albuterol Versus Levalbuterol Used as a Continuous Nebulization for the Treatment of Acute Asthma Exacerbations: a Randomized, Double-blind, Clinical Trial." The Journal of Asthma : Official Journal of the Association for the Care of Asthma, vol. 48, no. 2, 2011, pp. 188-93.
Wilkinson M, Bulloch B, Garcia-Filion P, et al. Efficacy of racemic albuterol versus levalbuterol used as a continuous nebulization for the treatment of acute asthma exacerbations: a randomized, double-blind, clinical trial. J Asthma. 2011;48(2):188-93.
Wilkinson, M., Bulloch, B., Garcia-Filion, P., & Keahey, L. (2011). Efficacy of racemic albuterol versus levalbuterol used as a continuous nebulization for the treatment of acute asthma exacerbations: a randomized, double-blind, clinical trial. The Journal of Asthma : Official Journal of the Association for the Care of Asthma, 48(2), 188-93. https://doi.org/10.3109/02770903.2011.554939
Wilkinson M, et al. Efficacy of Racemic Albuterol Versus Levalbuterol Used as a Continuous Nebulization for the Treatment of Acute Asthma Exacerbations: a Randomized, Double-blind, Clinical Trial. J Asthma. 2011;48(2):188-93. PubMed PMID: 21275850.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of racemic albuterol versus levalbuterol used as a continuous nebulization for the treatment of acute asthma exacerbations: a randomized, double-blind, clinical trial. AU - Wilkinson,Matthew, AU - Bulloch,Blake, AU - Garcia-Filion,Pam, AU - Keahey,Laine, Y1 - 2011/01/29/ PY - 2011/2/1/entrez PY - 2011/2/1/pubmed PY - 2011/5/4/medline SP - 188 EP - 93 JF - The Journal of asthma : official journal of the Association for the Care of Asthma JO - J Asthma VL - 48 IS - 2 N2 - OBJECTIVE: To compare racemic albuterol (RAC) with levalbuterol (LEV) in continuous form for the treatment of acute pediatric asthma exacerbations in the emergency department. STUDY DESIGN: Children between the ages of 6 and 17 inclusive were enrolled if they had a history of asthma, presented to the emergency department with an acute asthma exacerbation, and had an initial forced expiratory volume in 1 second (FEV1) <70% predicted. Patients were then randomized to receive either 7.5 mg of RAC or 3.75 mg of LEV over 1 hour, in addition to standard asthma therapies. Spirometry and asthma scoring were performed at the end of the first hour, and a second hour-long nebulization with the same drug was administered if deemed necessary. Spirometry and asthma scoring were again performed and the final disposition was recorded. As a second, optional part of the study, baseline serum albuterol levels were collected on some patients before treatment. RESULTS: A total of 99 patients completed the study (44 RAC and 55 LEV). Baseline characteristics were similar except that the RAC group had a higher baseline asthma score. Children in the RAC group had a greater improvement in their FEV1 (p = .043) as well as in their asthma scores (p = .01) after 1 hour of continuous treatment compared to the LEV group. The greater improvement in asthma scores was maintained after the second hour of continuous therapy in the RAC group (p = .008) but not for FEV1 measurements (p = .57). There were no differences between groups for changes in heart rate, respiratory rate, oxygen saturation, or rates of admission. CONCLUSIONS: At the doses used, RAC appears to be superior to LEV with respect to changes in FEV1 and asthma score. There was no significant difference between the drugs with respect to admission rates or side-effect profile. SN - 1532-4303 UR - https://www.unboundmedicine.com/medline/citation/21275850/Efficacy_of_racemic_albuterol_versus_levalbuterol_used_as_a_continuous_nebulization_for_the_treatment_of_acute_asthma_exacerbations:_a_randomized_double_blind_clinical_trial_ L2 - http://www.tandfonline.com/doi/full/10.3109/02770903.2011.554939 DB - PRIME DP - Unbound Medicine ER -