title: Comparison of levalbuterol and racemic albuterol combined with ipratropium bromide in acute pediatric asthma: a randomized controlled trial.
abstract: Our study compared levalbuterol (LEV) to the combination of racemic albuterol (RAC) and ipratropium bromide (IB) in 140 patients aged 6-18 years presenting to a tertiary hospital Emergency Department with acute asthma and a peak expired flow rate (PEF)<80% predicted. Patients were randomized to: LEV (<or=6 nebs LEV 1.25 mg); or RAC/IB (<or=3 nebs RAC 5.0 mg+IB 0.25 mg followed as needed by <or=3 nebs RAC 5.0 mg). No difference was noted in the study population (mean age 11.6 years and initial mean predicted PEF 49.5%) between LEV (n=72) and RAC/IB (n=68) for study outcomes except for measures of heart rate (HR). Median % HR increase for RAC/IB (26%) exceeded LEV (9%) (p<0.001). In a sample of children with acute asthma and initial mean PEF<50% predicted, LEV was associated with less tachycardia but had no other advantage over RAC combined with IB.
authors.affiliation: Department of Emergency Medicine, Naval Medical Center, Portsmouth, Virginia, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Ralston
authors.forename: Michael S
authors.initials: MS
authors.lastname: Euwema
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Knecht
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Ziolkowski
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Coakley
authors.forename: Shane M
authors.initials: SM
authors.lastname: Cline
mesh_terms: D000208:Acute Disease; D000280:Administration, Inhalation; D000293:Adolescent; D000420:Albuterol / Q000008:administration & dosage*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D004338:Drug Combinations; D004635:Emergency Medicine / Q000379:methods; D005260:Female; D006801:Humans; D009241:Ipratropium / Q000008:administration & dosage*; D008297:Male; D009330:Nebulizers and Vaporizers; D010372:Pediatrics / Q000379:methods; D012129:Respiratory Function Tests; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D004338:Drug Combinations; D009241:Ipratropium; D000420:Albuterol