Original Research: Critical Care |

Albuterol Administration Is Commonly Associated With Increases in Serum Lactate in Patients With Asthma Treated for Acute Exacerbation of AsthmaAlbuterol Increases Lactate in Asthma Exacerbation

Lawrence M. Lewis, MD; Ian Ferguson, BA; Stacey L. House, MD, PhD; Kristen Aubuchon; John Schneider, BA; Kirk Johnson, PhD; Kazuko Matsuda, MD, PhD
Author and Funding Information

From the Washington University School of Medicine in St. Louis (Drs Lewis and House, Messrs Ferguson and Schneider, and Ms Aubuchon), St. Louis, MO; and MediciNova, Inc (Drs Johnson and Matsuda), La Jolla, CA.

Correspondence to: Lawrence M. Lewis, MD, Washington University School of Medicine in St. Louis, 660 S Euclid Ave, Campus Box 8072, St. Louis, MO 63110; e-mail: lewisl@wusm.wustl.edu

For editorial comment see page 6

Part of this article was presented in abstract form at the Society for Academic Emergency Medicine Annual Meeting in Chicago, IL, May 9-12, 2012.

Funding/Support: This study was part of a larger industry-sponsored clinical study. There was no funding provided for manuscript preparation and submission.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2014;145(1):53-59. doi:10.1378/chest.13-0930
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Background:  Controversy exists around the incidence and cause of hyperlactatemia during asthma exacerbations. We evaluated the incidence, potential causes, and adverse events of hyperlactatemia in patients with acute asthma exacerbation.

Methods:  This study was a subanalysis of subjects receiving placebo from a prospective, randomized trial evaluating an IV β-adrenergic agonist in acute asthma exacerbation. Plasma albuterol, serum lactate, and bicarbonate concentrations were measured at baseline and 1.25 h, and dyspnea score and spirometry were measured at baseline and hourly for 3 h. All subjects had a therapeutic trial comprising 5 to 15 mg nebulized albuterol, 0.5 to 1 mg nebulized ipratropium, and at least 50 mg oral prednisone or its equivalent prior to initiation of the study. Following randomization, subjects were treated with continued albuterol and IV magnesium at the discretion of their treating physician. Subjects were followed to hospital admission or discharge with follow-up at 24 h and 1 week.

Results:  One hundred seventy-five subjects were enrolled in the parent trial, with 84 in the placebo group. Sixty-five had complete data. Mean ± SD albuterol administration prior to baseline was 12.3 ± 5.3 mg. Mean baseline lactate was 18.5 ± 8.4 mg/dL vs 26.5 ± 11.8 mg/dL at 1.25 h (P < .001). Forty-five subjects (69.2%) had hyperlactatemia. Mean baseline bicarbonate level was 22.6 ± 2.9 mEq/L vs 21.9 ± 4.0 mEq/L at 1.25 h (P = .11). Plasma albuterol concentration correlated with lactate concentration (β = 0.45, P < .001) and maintained a significant association after adjusting for asthma severity (β = 0.41, P = .001). Hyperlactatemia did not increase the risk of hospitalization or relapse (P = .26) or was associated with lower FEV1 % predicted at 3 h (P = .54).

Conclusions:  Plasma albuterol was significantly correlated with serum lactate concentration after adjusting for asthma severity. Hyperlactatemia was not associated with poorer pulmonary function as measured by 3-h FEV1 % predicted or increased hospitalization or relapse at 1 week.

Trial registry:  Clinicaltrials.gov; No.: NCT00683449; URL: www.clinicaltrials.gov

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