Comparison of levalbuterol and racemic albuterol combined with ipratropium bromide in acute pediatric asthma: A randomized controlled trial

Levalbuterol versus albuterol

“…However, several smaller (n = 70-140) pediatric asthma ED clinical studies reported no difference between racemic albuterol and levalbuterol for primary outcome measures, which included FEV 1 , oxygen saturations, respiratory rates, peak fl ow rates, and length of ED stay in some studies, or secondary outcomes, which included number of treatments, length of ED stay, and hospital admission rates in others [69][70][71]. Some of the acknowledged study limitations included study size [69] and the inability of some children to perform reliable pulmonary function tests [71], whereas other limitations included confounding variables such as additional administration of steroids and ipratropium during albuterol treatment [69,71], administration of racemic albuterol at four times the dose of levalbuterol (5 mg racemic albuterol vs 1.25 mg levalbuterol) [70], administration of ipratropium only to the racemic albuterol group [70], and exclusion of study participants who had taken levalbuterol but not racemic albuterol [71].…”

“…Some of the acknowledged study limitations included study size [69] and the inability of some children to perform reliable pulmonary function tests [71], whereas other limitations included confounding variables such as additional administration of steroids and ipratropium during albuterol treatment [69,71], administration of racemic albuterol at four times the dose of levalbuterol (5 mg racemic albuterol vs 1.25 mg levalbuterol) [70], administration of ipratropium only to the racemic albuterol group [70], and exclusion of study participants who had taken levalbuterol but not racemic albuterol [71]. These confounds make it diffi cult to evaluate the meaning of the results of those studies; however, most agree that further research is necessary.…”

Chiral Switch Drugs for Asthma and Allergies: True Benefit or Marketing Hype

“…14,15 Several studies in children in both the emergency department (ED) and hospital have failed to find clinically important advantages that are consistent between studies for levalbuterol versus the racemate. [16][17][18][19][20][21] Two studies in children evaluating higher doses of levalbuterol by continuous nebulization in the ED (3.75 mg/h levalbuterol vs. 7.5 mg/h albuterol) 20 and hospital (10 mg/h levalbuterol vs. 20 mg/h albuterol) 21 also measured (S)-albuterol serum concentrations to determine if levels affected outcomes. In both studies, there was no difference in clinical outcomes between levalbuterol and albuterol despite higher (S)-albuterol serum concentrations in the albuterol group.…”

Pharmacological strategies for self-management of asthma exacerbations: Table 1—

“…For regular administration in chronic stable asthma, the evidence from randomised double-blind studies is mixed, with one study supporting [61] and one not supporting [62] a therapeutic advantage for levalbuterol. There do not appear to have been any double-blind studies comparing levalbuterol and racemic albuterol in the management of asthma exacerbations in adults, and several recent double-blind studies in acute asthma in children have failed to find a therapeutic advantage for levalbuterol [63][64][65]. The observed development of bronchodilator tolerance with regular administration of SABA [66] is obviously of concern in the context of increasing b 2 -agonist usage during asthma exacerbations, but the initial suggestion that such tachyphylaxis may be due to (S)-albuterol [61] appears not to be supported by evidence [67,68].…”