title: (R)-salbutamol in the treatment of asthma and chronic obstructive airways disease.
abstract: BACKGROUND
  Asthma and chronic obstructive pulmonary disease (COPD) are inflammatory disorders that have an increasing prevalence and associated morbidity and mortality. β(2)-adrenoceptor agonists (β(2)-agonists) act by stimulating the β(2)-adrenoceptor present on airway smooth muscle and other cells in the airway, resulting in bronchodilatation. β(2)-agonists are among the most commonly used drugs in the world and remain pivotal in the treatment of symptoms in patients with asthma and COPD. Salbutamol is a chiral drug with (R)- and (S)- isomers. Almost all β(2)-agonists that are used at present are racemic mixtures of (R)- and (S)-salbutamol.
  
  
  METHODS
  In this review the authors show that (R)-salbutamol alone (generically known as levosalbutamol) provides beneficial β(2)-agonist effects at a cellular level and in experimental models of airways disease. In addition the authors demonstrate that (S)-salbutamol opposes the desirable effects of (R)-salbutamol and can actually cause features of asthma and COPD in vitro and in experimental asthma.
  
  
  CONCLUSIONS
  Despite this strong body of experimental evidence, (R)-salbutamol has not shown consistent superiority over (S)- or racemic salbutamol in human asthma or COPD.
authors: Wishaw Hospital, Department of Respiratory Medicine, Lanarkshire, UK. manishpatel2@nhs.net
authors: Manish
authors: M
authors: Patel
authors: Neil C
authors: NC
authors: Thomson
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D000420:Albuterol / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D001993:Bronchodilator Agents / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology; D018343:Receptors, Adrenergic, beta-2 / Q000378:metabolism; D012137:Respiratory System / Q000187:drug effects; D013237:Stereoisomerism
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D018343:Receptors, Adrenergic, beta-2; D000420:Albuterol