Comparison of racemic albuterol and levalbuterol for treatment of acute asthma☆

Abstract 

Objective

To determine whether levalbuterol resulted in fewer hospital admissions than racemic albuterol when used for treatment of acute asthma.

Study design

A randomized, double-blind, controlled trial was conducted in the emergency department (ED) and inpatient asthma care unit of an urban tertiary children's hospital. Children age 1 to 18 years (n=482) provided a total of 547 enrollments. Patients received a nebulized solution of either 2.5 mg racemic albuterol or 1.25 mg levalbuterol every 20 minutes (maximum six doses). Patients admitted to the asthma care unit were treated in a standardized fashion by using the same blinded drug assigned in the ED. Hospitalization rate was the primary outcome.

Results

Hospitalization rate was significantly lower in the levalbuterol group (36%) than in the racemic albuterol group (45 %, P=.02). The adjusted relative risk of admission in the racemic group compared with the levalbuterol group was 1.25 (95% confidence interval, 1.01-1.57). Hospital length of stay was not significantly shorter in the levalbuterol group (levalbuterol, 44.9 hours; racemic albuterol, 50.3 hours; P=.63). No significant adverse events occurred in either group.

Conclusions

Substituting levalbuterol for racemic albuterol in the ED management of acute asthma significantly reduced the number of hospitalizations.

Abbreviations:  ACA, Asthma care algorithm, ACU, Asthma care unit, CI, Confidence interval, ED, Emergency department, GEE, Generalized estimating equation, LOS, Length of stay, PICU, Pediatric intensive care unit