title: Comparison of racemic albuterol and levalbuterol for treatment of acute asthma.
abstract: OBJECTIVE
  To determine whether levalbuterol resulted in fewer hospital admissions than racemic albuterol when used for treatment of acute asthma. Study design A randomized, double-blind, controlled trial was conducted in the emergency department (ED) and inpatient asthma care unit of an urban tertiary children's hospital. Children age 1 to 18 years (n=482) provided a total of 547 enrollments. Patients received a nebulized solution of either 2.5 mg racemic albuterol or 1.25 mg levalbuterol every 20 minutes (maximum six doses). Patients admitted to the asthma care unit were treated in a standardized fashion by using the same blinded drug assigned in the ED. Hospitalization rate was the primary outcome.
  
  
  RESULTS
  Hospitalization rate was significantly lower in the levalbuterol group (36%) than in the racemic albuterol group (45 %, P=.02). The adjusted relative risk of admission in the racemic group compared with the levalbuterol group was 1.25 (95% confidence interval, 1.01-1.57). Hospital length of stay was not significantly shorter in the levalbuterol group (levalbuterol, 44.9 hours; racemic albuterol, 50.3 hours; P=.63). No significant adverse events occurred in either group.
  
  
  CONCLUSIONS
  Substituting levalbuterol for racemic albuterol in the ED management of acute asthma significantly reduced the number of hospitalizations.
authors.affiliation: Department of Pediatrics, Case Western Reserve University, University Hospitals of Cleveland, Rainbow Babies and Children's Hospital, Cleveland, Ohio 44106, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Carl
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Myers
authors.forename: H Lester
authors.initials: HL
authors.lastname: Kirchner
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Kercsmar
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000420:Albuterol / Q000737:chemistry* / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000737:chemistry* / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007536:Isomerism; D008297:Male
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol