Abstract: Slide Presentations |

FEV1 Response to Levalbuterol vs Racemic Albuterol in Acute Severe Asthma FREE TO VIEW

Nicola Hanania, MD*; Charles Emerman, MD; Richard Nowak, MD; Raymond Claus; James Roach, MD; William McVicar; John Hanrahan, MD
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Baylor College of Medicine, Houston, TX


Chest. 2004;126(4_MeetingAbstracts):722S. doi:10.1378/chest.126.4_MeetingAbstracts.722S-b
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PURPOSE:  A multicenter double-blind randomized trial to evaluate Levalbuterol (LEV) vs Racemic Albuterol (RAC) in acute severe asthma.

METHODS:  Among 627 adult patients in this trial, 315 received LEV 1.25 mg and 312 received RAC 2.5 mg. Drug was nebulized every 20 min for 3 doses, then every 40 min for doses 4 to 6. All patients received systemic steroids at the initiation of treatment. FEV1 and clinical improvement were evaluated before each dose until discharge or hospital admission.

RESULTS:  Asthma severity was similar in both LEV and RAC patients, based on presenting FEV1, prior reported rescue medication and corticosteroid use. FEV1 improvement was significantly greater in the LEV-treated patients after the first dose (LEV 0.50 L vs. RAC 0.43 L; difference (D)= 0.07L 95% CI 0.01-0.14L). Treatment differences of similar magnitude persisted after the last dose. Differences were greatest in patients without prior steroid therapy (LEV 0.58 L vs. RAC 0.45L; D= 0.13L, 95% CI 0.04-0.22L), and among the 379 patients who improved sufficiently to be discharged after < 3 doses (LEV 0.68L vs. RAC 0.55L: D= 0.12L, 95% CI 0.04 - 0.21L). In patients with plasma (S)-albuterol levels measured at presentation (n=160), these levels (reflecting prior recent RAC use) were associated with hospital admission (p<0.01) and inversely associated with FEV1 improvement, results most pronounced in RAC-treated patients.

CONCLUSION:  In this study, LEV resulted in faster and greater FEV1 improvement than RAC. Plasma (S)-albuterol levels positively correlated with admission and inversely correlated with FEV1 improvement.

CLINICAL IMPLICATIONS:  This study suggests that LEV may be a more effective bronchodilator than RAC in acute severe asthma.

DISCLOSURE:  N. Hanania, Clinical Investigator for Sepracor Inc.

Monday, October 25, 2004

2:30 PM- 4:00 PM




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