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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, Mr Ferguson, and Ms Aubuchon); the University of Missouri Columbia School of Medicine (Mr Schneider); and MediciNova, Inc (Drs Johnson and Matsuda).

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


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Lewis was a principle investigator for the larger clinical trial sponsored by MediciNova, Inc. Drs Johnson and Matsuda are employed by MediciNova, Inc, the sponsoring company for the larger clinical trial. Messrs Ferguson and Schneider, Dr House, and Ms Aubuchon have reported 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.14-0344
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To the Editor:

We appreciate the letter from Dr Claret and colleagues questioning the need for serum lactate measurements in patients being treated for acute exacerbation of asthma. Our study, part of a clinical trial protocol, required repeated measures of a number of laboratory values, including plasma albuterol, serum electrolytes, and serum lactate concentrations.1 We agree with Dr Claret and colleagues that this study and others have demonstrated that most patients treated for acute exacerbation of asthma who subsequently develop elevated serum lactate concentrations have no discernable worsening of outcomes and require no alteration in management.2,3 Thus, the routine use of serum lactate measurements in these patients is not warranted.

However, we and others have described occasional subjects with worsening dyspnea and stable pulmonary function who were found to have hyperlactatemia and who clinically improved when β-agonists were withheld.4,5 It is not unreasonable to consider testing of serum lactate concentrations (particularly rapid point-of-care testing) in patients with worsening subjective dyspnea, in the face of stable pulmonary function based on clinical or spirometric features, to determine if hyperlactatemia and acidosis may be the cause.

Finally, the lactate concentration Dr Claret and colleagues report of 10.47 mmol/L is higher than the maximum lactate concentration measured in any of our subjects. However Koul et al6 reported a lactate concentration of 13 mmol/L in a case report of a 17-year-old who recovered uneventfully.

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. 2014;145(1):53-59.
 
Stratakos G, Kalomenidis J, Routsi C, Papiris S, Roussos C. Transient lactic acidosis as a side effect of inhaled salbutamol. Chest. 2002;122(1):385-386.
 
Rodrigo GJ, Rodrigo C. Elevated plasma lactate level associated with high dose inhaled albuterol therapy in acute severe asthma. Emerg Med J. 2005;22(6):404-408.
 
Maury E, Ioos V, Lepecq B, Guidet B, Offenstadt G. A paradoxical effect of bronchodilators. Chest. 1997;111(6):1766-1767.
 
Tobin A, Santamaria J. Respiratory failure precipitated by salbutamol. Intern Med J. 2005;35(3):199-200.
 
Koul PB, Minarik M, Totapally BR. Lactic acidosis in children with acute exacerbation of severe asthma. Eur J Emerg Med. 2007;14(1):56-58.
 

Figures

Tables

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. 2014;145(1):53-59.
 
Stratakos G, Kalomenidis J, Routsi C, Papiris S, Roussos C. Transient lactic acidosis as a side effect of inhaled salbutamol. Chest. 2002;122(1):385-386.
 
Rodrigo GJ, Rodrigo C. Elevated plasma lactate level associated with high dose inhaled albuterol therapy in acute severe asthma. Emerg Med J. 2005;22(6):404-408.
 
Maury E, Ioos V, Lepecq B, Guidet B, Offenstadt G. A paradoxical effect of bronchodilators. Chest. 1997;111(6):1766-1767.
 
Tobin A, Santamaria J. Respiratory failure precipitated by salbutamol. Intern Med J. 2005;35(3):199-200.
 
Koul PB, Minarik M, Totapally BR. Lactic acidosis in children with acute exacerbation of severe asthma. Eur J Emerg Med. 2007;14(1):56-58.
 
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