Levalbuterol for asthma: A better treatment?

Abstract

The purpose of this review is to determine whether the proinflammatory actions identified in vitro for (S)-albuterol provide a clinically significant therapeutic advantage for levalbuterol over racemic albuterol. Clinical trials evaluating the bronchodilation in chronic and acute asthma provide conflicting evidence. Older trials suggested an advantage for levalbuterol; however, the newer trials have failed to confirm those advantages. Although (S)-albuterol produces increased bronchial hyperresponsiveness in vitro and in animal models, this has not been consistently confirmed in clinical trials; however, the heterogeneity of the trials precludes definitive conclusions. Current clinical trials do not provide evidence of a substantial advantage of levalbuterol over racemic albuterol although the data are insufficient to determine whether subsets of the patient population might benefit from single isomer therapy.

Asthma Exacerbations: Pathogenesis, Prevention, and Treatment

“… 107 Levalbuterol, the R-enantiomer of albuterol, and albuterol are equivalent. 111 , 112 , 113 Data are conflicting whether continuous nebulization with a SABA is superior to intermittent nebulization. 114 , 115 In very severe asthma exacerbations, continuous nebulization should be considered based on evidence of reduced admissions and improved pulmonary function.…”

Corticosteroids in the treatment of acute asthma

“…Levalbuterol, the (R)-enantiomer of albuterol is the effective form of the drug, but clinical trials did not show any advantage of using it over albuterol in terms of efficacy or side-effects. [21] Most patients with mild asthma exacerbation will not require systemic corticosteroids. However, it is recommended that patients who take them regularly or patients who fail initial treatment with albuterol should be given systemic corticosteroids.…”

The Use of Glucocorticoids in the Treatment of Acute Asthma Exacerbations

“…The dose can be repeated 3 times every 15-20 minutes. Levalbuterol, the (R)-enantiomer of albuterol is the effective form of the drug, but clinical trials did not show any advantage of using it over albuterol in terms of efficacy or side effects (Kelly, 2007). Most patients with mild asthma exacerbation will not require systemic glucocoricoids.…”