The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

LEVALBUTEROL USE IN THE EMERGENCY DEPARTMENT (ED) INCREASES PEF OVER RACEMIC ALBUTEROL

Debbie Ford, RRTa, Steven Dilley, CRTa, Dean Handley, PhD, MBAb. aSouthern Maryland Hospital Center, Respiratory Care Services, Clinton, MD bSepracor Inc, Marlborough, MA

Racemic albuterol [(R,S)-albuterol] is the most widely used b agonist for the treatment of acute airway obstruction. However, only 50% of the clinical dose of racemic albuterol has bronchodilatory activity; (R)-albuterol or levalbuterol (eutomer). (S)-albuterol (distomer) provides no clinical benefit and may be detrimental to airway tissue and cells. Recently, levalbuterol (Xopenex?) became available in nebulizer solution. Southern Maryland Hospital Center performed an open labeled trial of levalbuterol (n=57) in comparison to racemic albuterol (n=47) in asthma patients who reported to the emergency department. Patients' peak expiratory flow (PEF) and heart rates were measured and compared. Additionally, each participant completed a survey for historical evaluation of adverse events. Patients 6 years and older were given 1.25 mg of nebulized levalbuterol, those 5 years and under received 0.63 mg of nebulized levalbuterol. In cases where racemic albuterol and Atrovent? were prescribed, levalbuterol and Atrovent? were administered for an equivalent comparison.

Drug Average change in PEF (ml) Dose 1 Average change in PEF (ml) Dose 2 Average total increase in PEF (ml)
Racemic albuterol 2.50 mg 27 23 50
Levalbuterol 0.63 mg 32 42 74
Levalbuterol 1.25 mg 53 41 94

The average total increase in PEF for 0.63 mg and 1.25 mg of levalbuterol was 48% and 88% greater, respectively, than 2.50 mg of racemic albuterol. The increased efficacy of levalbuterol over racemic albuterol may relate to the removal of (S)-albuterol.

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