The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

COMPARISON IN RATES OF BREAKTHROUGH TREATMENTS DURING A CONVERSION FROM RACEMIC ALBUTEROL TO LEVALBUTEROL

Robert S Pikarsky, BSRT, Russell A. Acevedo, MD, FAARC, FCCP, Tracey Farrell, RRT, Renee Bear, RRT and Wendy Fascia, RRT. Respiratory Care, Crouse Hospital, Syracuse, New York.

Purpose: In order to meet our adult patient care demands, Crouse Hospital approved an automatic conversion from Racemic Albuterol to Levalbuterol. This study compares the breakthrough rates of Racemic Albuterol and Levalbuterol, with and without Ipratropium. Different dosing schedules for Levalbuterol were evaluated

Methods: Racemic Albuterol (Alb) 2.5 mg Q4h was converted to either Levalbuterol (Lev) 0.63 mg Q6h or Levalbuterol 0.63 mg Q8h. Patients dosed Q8h who required more frequent aerosol administration received Levalbuterol 0.63 mg Q6h (cardiac patients) or Levalbuterol 1.25 mg Q8h (all others). If ordered, Ipratropium (Ipra) 0.5 mg was administered at the same frequency as the Levalbuterol. A majority of aerosol therapy was provided with the use of the AeroEclipse Breath Actuated Nebulizer (BAN). All aerosol treatments, including breakthrough treatments, delivered between June 1, 2002 and September 30, 2002 were recorded.

Results: Tx/Pt/day represents the number of treatments delivered per patient per day. Rate/100 Pt/days = (Breakthrough) / (Total Tx / Tx/Pt/day) x 100. Rate/100 Pt/days corrects for the differences in daily administration frequency, and may better reflect the daily impact of the breakthrough rate. The breakthrough rate of the combined Albuterol group was significantly greater than all Levalbuterol groups (25.8 vs. 18.43, 25.8 vs. 18.43, 25.8 vs. 5.96 p<.001)*. The breakthrough rate with Albuterol was significantly reduced with the addition of Ipratropium (40.76 vs. 13.35 p<.001)**. The 1.25 mg dose of Levalbuterol outperformed both 0.63 mg dosage groups (3.78 vs. 13.48 p<.02, 3.78 vs. 21.36 p<.001) ***. Ipratropium did not significantly change the breakthrough rate when added to Levalbuterol groups.

Medication Total Tx Breakthrough Rate/1000 Tx/Pt/day Rate/100 Pt/day
Alb Q4h 898 61 67.93 6 40.76** 25.80*
Alb/Ipra Q4h 1079 24 22.24 6 13.35**  
Lev 0.63mg Q6h 2047 69 33.71 4 13.48*** 18.43*
Lev 0.63 mg/Ipra Q6h 2728 151 55.35 4 22.14  
Lev 0.63mg Q8h 660 47 71.21 3 21.36*** 18.43*
Lev 0.63 mg/Ipra Q8h 707 37 52.33 3 15.70  
Lev 1.25mg Q8h 238 3 12.61 3 3.78*** 5.96*
Lev 1.25mg/Ipra Q8h 215 6 27.91 3 8.37  



Conclusions: The conversion from Racemic Albuterol to Levalbuterol allowed for a decreased frequency of daily medication administrations and a significant decrease in breakthrough requirements. Levalbuterol at the 1.25 mg dose performed better than the 0.63 dose for Q8h administration. Ipratropium showed a significant benefit in breakthrough reduction for the Racemic Albuterol group.

Clinical Implications: The efficiencies gained by decreasing the daily frequency of aerosol administration can have a significant impact on resource utilization. The conversion to Levalbuterol allows for decreased respiratory therapy time or the re-allocating of workforce needs while maintaining, or improving, quality of aerosol administration, as evidenced by the decrease in breakthrough requirements. 

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