title: Levosalbutamol  for chronic obstructive pulmonary disease: a treatment evaluation.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is an inflammatory disorder associated with considerable morbidity and mortality. β2-adrenoceptor agonists (β2-agonists) act by stimulating the β2-adrenoceptor present on smooth muscle and other cells in the airways, resulting in bronchodilatation. β2-agonists play a central role in the treatment of breathlessness in patients with COPD. Salbutamol is a chiral drug with (R)- and (S)- isomers. Almost all β2-agonists that are currently used are racemic mixtures of (R)- and (S)-salbutamol.
  
  
  METHODS
  (R)-salbutamol alone (Xenopex®, generically known as levosalbutamol) is now indicated for the treatment or prevention of bronchospasm with reversible obstructive airway disease. This evaluation demonstrates that (R)-salbutamol provides a beneficial β2-agonist effect at a cellular level and in experimental models of airways disease. Furthermore, we 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 preclinical experimental evidence, (R)-salbutamol has not shown consistent superiority over (S)- or racemic salbutamol in the treatment of patients with COPD.
authors.affiliation: Wishaw Hospital, Department of Respiratory Medicine, 50 Netherton Road, Wishaw, Lanarkshire ML2 0DP, UK. manishpatel2@nhs.net
authors.forename: Manish
authors.initials: M
authors.lastname: Patel
authors.forename: Neil C
authors.initials: NC
authors.lastname: Thomson
mesh_terms: D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000420:Albuterol / Q000737:chemistry / Q000627:therapeutic use*; D000818:Animals; D002986:Clinical Trials as Topic; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D013237:Stereoisomerism
chemical_list: D000318:Adrenergic beta-Agonists; D000420:Albuterol