2001 OPEN FORUM Abstracts
LEVALBUTEROL (LEV) AFFORDS SUPERIORHEALTH AND COST BENEFIT OVER RACEMIC ALBUTEROL (RAC) IN THE EMERGENCY DEPARTMENT(ED).
Deb Haider, RPFT, CRT, RCP NorthMemorial Medical Center, Minneapolis, MN 55422
RAC, the most common b2-agonistbronchodilator used in the treatment of acute asthma exacerbation, is comprisedof 50:50 mixture of (R)- and (S)-albuterol; however, only (R)-albuterol (levalbuterol)provides bronchodilatory activity. This study compared LEV and RAC for the treatmentof acute bronchoconstriction from primary asthma in the ED. Patients (>12 yearsof age) were administered either RAC (n=30) or LEV (n=24). Atrovent¨ was administeredconcomitantly with the first dose of either b2-agonist but then only as subjectivelynecessary. Mean initial PEF (L/min) and FEV1 (L) were measured in a subset ofRAC (n=16) and LEV (n=13) patients and were similar between the treatment groups(PEF, 209.2 vs. 208.6; FEV1, 1.21 vs. 1.17). Pulmonary function improved inpatients administered either b2-agonist, however, the extent of improvementwas greater among LEV patients compared to RAC patients (%ÆPEF, 68% for LEVvs. 46% for RAC; %ÆFEV1, 70% for LEV vs. 34% for RAC). Greater bronchodilationwas achieved with lower total amounts of LEV (3 mg/patient) compared to RAC(11.5 mg/patient). In addition, total Atrovent amounts utilized were ~3-foldlower in LEV patients (0.45 mg) compared to RAC patients (1.5 mg). LEV patientsexperienced decreased heart and respiratory rate suggesting resolution of hypoxiaand reduced anxiety. In contrast, RAC patients showed increased heart rate andless of a decrease in respiratory rate. Also, decreased incidence of b2-agonist-associatedside effects (tremor, nervousness, tachycardia, dizziness, nausea, cough andheadache) were observed in LEV patients compared to RAC patients. Twenty percentof RAC patients were admitted to the hospital subsequent to ED therapy, while12% of LEV patients were admitted. Length of hospital stay was 35 hours forRAC patients and 23 hours for LEV patients. Despite the higher cost of LEV ($1.54/unitdose) compared to RAC ($0.30/2.5 mg unit dose; $0.60/5.0 mg unit dose) and Atrovent($1.12/0.5 mg unit dose); the total cost of bronchodilator therapy between thetwo groups was similar ($4.89 and $4.23 for LEV and RAC, respectively). Thisresulted from fewer LEV and Atrovent administrations necessary to achieve bronchodilation.These data suggest that LEV, compared to RAC, is a clinically superior bronchodilator,decreases b2-mediated side effects, improves clinical outcomes, and providescost efficient asthma management in the ED.