A comparison of levalbuterol with racemic albuterol in the treatment of acute severe asthma exacerbations in adults
| Autor: | Rudolf A. Baumgartner, John P. Hanrahan, Nicola A. Hanania, Charles L. Emerman, Raymond Claus, Kendyl Schaefer, Richard Nowak, Merdad V. Parsey |
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| Rok vydání: | 2006 |
| Předmět: |
Adult
Male medicine.drug_class Statistics Nonparametric Double-Blind Method Prednisone Intensive care Bronchodilator Administration Inhalation Levalbuterol medicine Humans Albuterol Prospective Studies Asthma Analysis of Variance Intention-to-treat analysis business.industry Nebulizers and Vaporizers General Medicine Adrenergic beta-Agonists medicine.disease Bronchodilator Agents Respiratory Function Tests respiratory tract diseases Treatment Outcome Anesthesia Acute severe asthma Acute Disease Emergency Medicine Salbutamol Female business medicine.drug |
| Zdroj: | The American Journal of Emergency Medicine. 24:259-267 |
| ISSN: | 0735-6757 |
| DOI: | 10.1016/j.ajem.2006.01.027 |
| Popis: | This multicenter, randomized, double-blind trial compared nebulized levalbuterol (Lev) and racemic albuterol (Rac) in the treatment of acute asthma. Methods Adults with acute asthma exacerbations (FEV 1 20%-55% predicted) received prednisone and either Lev (1.25 mg, n=315) or Rac (2.5 mg, n=312). Nebulized treatments were administered every 20 minutes in the first hour, then every 40 minutes for 3 additional doses, then as necessary for up to 24 hours. The primary end point was time to meet discharge criteria. Secondary end points included changes in lung function and hospitalization rates. A subset of 160 patients had plasma ( S )-albuterol concentrations determined at study entry. Results Time to meet discharge criteria did not differ between the 2 treatments. FEV 1 improvement was greater following Lev compared with Rac, both after dose 1 and cumulatively over the entire treatment period (dose 1 in intent to treat [ITT] group: Lev 0.50 ± 0.43 L, Rac 0.43 ± 0.37 L; P = .02), particularly among the 60% of patients not on recent steroid therapy (dose 1: Lev 0.58 ± 0.47 L, Rac 0.44 ± 0.37 L; P S )-albuterol concentrations were in the highest quartile of those measured. A small and similar proportion of Lev-treated (7.0%) and Rac-treated (9.3%) patients required hospitalization ( P = .28). Among patients not on steroids, fewer Lev- than Rac-treated patients required admission (3.8% vs 9.3%, P = .03), as was also the case for patients with high plasma ( S )-albuterol concentrations. Asthma relapses (5% in 30 days) were lower than in previous reports and did not differ between groups. Conclusions This study suggests that early, regular nebulized β 2 -agonist and systemic corticosteroid therapy may reduce hospitalization and relapse rates in patients with acute severe asthma. Lev was well tolerated and compared favorably with Rac in improving airway function, particularly in those who were not on inhaled or oral corticosteroids and in those who had high plasma ( S )-albuterol concentrations at presentation. |
| Databáze: | OpenAIRE |
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