The Journal of Pediatrics
Volume 155, Issue 2 , Pages 205-210.e1 , August 2009

High-Dose Continuous Nebulized Levalbuterol for Pediatric Status Asthmaticus: A Randomized Trial

  • Timothy Andrews, MD

      Affiliations

    • The Children's Hospital of Philadelphia, Philadelphia, PA and the Division of Allergy and Immunology, University of Pennsylvania School of Medicine, Philadelphia, PA
    • ,
  • Erin McGintee, MD

      Affiliations

    • The Children's Hospital of Philadelphia, Philadelphia, PA and the Division of Allergy and Immunology, University of Pennsylvania School of Medicine, Philadelphia, PA
    • ,
  • Manoj K. Mittal, MD

      Affiliations

    • Division of Pediatric Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
    • ,
  • Lisa Tyler, RRT

      Affiliations

    • Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
    • ,
  • Amber Chew

      Affiliations

    • Division of Pediatric Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
    • ,
  • Xuemei Zhang, MS

      Affiliations

    • Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
    • ,
  • Nicholas Pawlowski, MD

      Affiliations

    • The Children's Hospital of Philadelphia, Philadelphia, PA and the Division of Allergy and Immunology, University of Pennsylvania School of Medicine, Philadelphia, PA
    • ,
  • Joseph J. Zorc, MD

      Affiliations

    • Division of Pediatric Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
    • Corresponding Author InformationReprint requests: Joseph J. Zorc, MD, Division of Emergency Medicine, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399.

Received 25 June 2008 ,Revised 16 December 2008 ,Accepted 30 January 2009.

References 

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  2. Weiss KB, Sullivan SD, Lyttle CS. Trends in the cost of illness for asthma in the United States, 1985-1994. J Allergy Clin Immunol. 2000;106:493–499
  3. Schuh S, Reider MJ, Canny G, Pender E, Forbes T, Tan YK, et al. Nebulized albuterol in acute childhood asthma: comparison of two doses. Pediatrics. 1990;86:509–513
  4. National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Institutes of Health; 2007;
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  7. Ameredes BT, Calhoun WJ. (R)-albuterol for asthma: pro [a.k.a. (S)-albuterol for asthma: con]. Am J Respir Crit Care Med. 2006;174:965–969
  8. Barnes PJ. Treatment with (R)-albuterol has no advantage over racemic albuterol. Am J Respir Crit Care Med. 2006;174:969–972
  9. Handley D. The asthma-like pharmacology and toxicology of (S)-isomers of beta agonists. J Allergy Clin Immunol. 1999;104:S69–S76
  10. Mitra S, Ugur M, Ugur O, Goodman HM, McCullough JR, Yamaguchi H. (S)-albuterol increases intracellular free calcium by muscarinic receptor activation and a phospholipase C-dependent mechanism in airway smooth muscle. Mol Pharmacol. 1998;53:347–354
  11. Volcheck GW, Kelkar P, Bartemes KR, Gleich GJ, Kita H. Effects of (R)- and (S)-isomers of beta-adrenergic agonists on eosinophil response to interleukin-5. Clin Exp Allergy. 2005;35:1341–1346
  12. Gumbhir-Shah K, Kellerman DJ, DeGraw S, Koch P, Jusko WJ. Pharmacokinetics and pharmacodynamics of cumulative single doses of inhaled salbutamol enantiomers in asthmatic subjects. Pulm Pharmacol Ther. 1999;12:353–362
  13. Nelson HS, Bensch G, Pleskow WW, DiSantostefano R, DeGraw S, Reasner DS, et al. Improved bronchodilation with levalbuterol compared with racemic albuterol in patients with asthma. J Allergy Clin Immunol. 1998;102:943–952
  14. Milgrom H, Skoner DP, Bensch G, Kim KT, Claus R, Baumgartner RA. Low-dose levalbuterol in children with asthma: safety and efficacy in comparison with placebo and racemic albuterol. J Allergy Clin Immunol. 2001;108:938–945
  15. Lotvall J, Palmqvist M, Arvidsson P, Maloney A, Ventresca GP, Ward J. The therapeutic ratio of R-albuterol is comparable with that of R(S)-albuterol in asthmatic patients. J Allergy Clin Immunol. 2001;108:726–731
  16. Berger WE, Milgrom H, Skoner DP, Tripp K, Parsey MV, Baumgartner RA. Evaluation of levalbuterol metered dose inhaler in pediatric patients with asthma: a double-blind, randomized, placebo- and active-controlled trial. Curr Med Res Opin. 2006;22:1217–1226
  17. Carl JC, Myers TR, Kirchner HL, Kercsmar CM. Comparison of racemic albuterol and levalbuterol for treatment of acute asthma. J Pediatr. 2003;143:731–736
  18. Qureshi F, Zaritsky A, Welch C, Meadows T, Burke BL. Clinical efficacy of racemic albuterol versus levalbuterol for the treatment of acute pediatric asthma. Ann Emerg Med. 2005;46:29–36
  19. Hardasmalani MD, DeBari V, Bithoney WG, Gold N. Levalbuterol versus racemic albuterol in the treatment of acute exacerbation of asthma in children. Pediatr Emerg Care. 2005;21:415–419
  20. Stevens MW, Gorelick MH, Schultz T. Interrater agreement in the clinical evaluation of acute pediatric asthma. J Asthma. 2003;40:311–315
  21. Gorelick MH, Stevens MW, Schultz TR, Scribano PV. Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma. Acad Emerg Med. 2004;11:10–18
  22. Gorelick MH, Stevens MW, Schultz TR. Comparability of acute asthma severity assessments by parents and respiratory therapists. Arch Pediatr Adolesc Med. 2002;156:1199–1202
  23. Nowak R, Emerman C, Hanrahan JP, Parsey MV, Hanania NA, Claus R, et al. A comparison of levalbuterol with racemic albuterol in the treatment of acute severe asthma exacerbations in adults. Am J Emerg Med. 2006;24:259–267
  24. Camargo CA, Spooner CH, Rowe BH. Continuous versus intermittent beta-agonists for acute asthma. Cochrane Database Syst Rev. 2003;4:CD001115
  25. Gorelick MH, Stevens MW, Schultz T, Scribano PV. Difficulty in obtaining peak expiratory flow measurements in children with acute asthma. Pediatr Emerg Care. 2004;20:22–26

 This investigator-initiated study was funded by an unrestricted research grant from Sepracor Inc. The authors declare no other affiliation, financial agreements, or involvement with this or any company that might be considered a conflict of interest.

 ClinicalTrials.gov registration number: NCT00124176.

PII: S0022-3476(09)00113-9

doi: 10.1016/j.jpeds.2009.01.073

The Journal of Pediatrics
Volume 155, Issue 2 , Pages 205-210.e1 , August 2009

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