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Correspondence |

Too Much Testing?Too Much Testing? FREE TO VIEW

Pierre-Géraud Claret, MD; Xavier Bobbia, MD; Jean-Emmanuel de La Coussaye, MD, PhD
Author and Funding Information

From CHU de Nîmes.

Correspondence to: Pierre-Géraud Claret, CHU de Nîmes, Place du Professeur Robert Debré, Nîmes 30000, France; e-mail: pierre.geraud.claret@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Chest. 2014;145(6):1436. doi:10.1378/chest.14-0252
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To the Editor:

In their recent article in CHEST (January 2014) on the treatment of acute asthma with albuterol, Lewis et al1 show that high levels of lactate during such treatment are highly prevalent; in addition, high plasma albuterol concentration is significantly correlated with hyperlactatemia. In a previous case involving a woman with asthma, we described lactic acidosis (pH 7.29) and a high level of arterial lactate (10.47 mmol/L) after treatment with bronchodilator aerosols (terbutaline).2 This level represents the highest level of lactate, without any grave consequences, that we were able to find in the literature. We concur with Lewis et al1 that hyperlactatemia, with or without lactic acidosis, is not necessarily a sign of immediate gravity and has no clinical consequences in these patients.

We also question the utility of measuring lactates in acute asthma. Advanced tests have dramatically changed how diseases are diagnosed and treated. A great evolution in medicine! However, we have to keep in mind that clinical examination is more important than the results of these tests, even if hyperlactatemia is present. Laboratory tests should be targeted, and physicians should not order tests if they do not think they will aid in patient management. The study by Lewis et al1 helps demonstrate this concept.

References

Lewis LM, Ferguson I, House SL, et al. Albuterol administration is commonly associated with increases in serum lactate in patients with asthma treated for acute exacerbation of asthma. Chest. 2013;145(1):53-59.
 
Claret PG, Bobbia X, Boutin C, Rougier M, de la Coussaye JE. Lactic acidosis as a complication of beta-adrenergic aerosols. Am J Emerg Med. 2012;30(7):1319.e5-1319.e6.
 

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References

Lewis LM, Ferguson I, House SL, et al. Albuterol administration is commonly associated with increases in serum lactate in patients with asthma treated for acute exacerbation of asthma. Chest. 2013;145(1):53-59.
 
Claret PG, Bobbia X, Boutin C, Rougier M, de la Coussaye JE. Lactic acidosis as a complication of beta-adrenergic aerosols. Am J Emerg Med. 2012;30(7):1319.e5-1319.e6.
 
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