Comparison of racemic albuterol and levalbuterol for treatment of acute asthma.
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.
Carl
John C
JC
Department of Pediatrics, Case Western Reserve University, University Hospitals of Cleveland, Rainbow Babies and Children's Hospital, Cleveland, Ohio 44106, USA.
Myers
Timothy R
TR
Kirchner
H Lester
HL
Kercsmar
Carolyn M
CM
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
D001993:Bronchodilator Agents; D000420:Albuterol