Carl JC, Myers TR, Kirchner L, et al. J Pediatr. 2003;143:731–736
Purpose of the Study.
Inhaled β-receptor agonists are widely used to treat bronchospasm and acute asthma exacerbations. Recently, a new β agonist, levalbuterol, which is the R-isomer of albuterol, was introduced. This study was conducted in an acute setting, to compare albuterol and levalbuterol.
This was a randomized, double-blind, controlled trial conducted in the emergency department and inpatient asthma care unit of a children’s hospital. Children were 1 to 18 years of age; the study group included 482 patients, with a total of 547 enrollments. Patients received a nebulized solution of either 2.5 mg of racemic albuterol or 1.25 mg of levalbuterol every 20 minutes, for a maximum of 6 doses. Children subsequently admitted to the asthma care unit were treated in a standardized manner, with continued administration of the drugs assigned in the emergency department. The primary outcome parameter was hospitalization rate.
The hospitalization rate was significantly lower for the levalbuterol group (36%) than for the racemic albuterol group (45%, P = .02). The adjusted relative risk of admission for the racemic albuterol group, compared with the levalbuterol group, was 1.25 (95% confidence interval: 1.01–1.57). There was no difference in the lengths of hospital stays, and there were no significant adverse events in either group.
Substituting levalbuterol for racemic albuterol in the emergency department treatment of acute asthma significantly reduced the number of hospitalizations.
Additional prospective trials, including pulmonary function studies and economic analyses, will be necessary to justify the use of levalbuterol, rather than albuterol, as standard practice.