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Journal of Asthma, Early Online, 1, 2011Copyright 2011 Informa Healthcare USA, Inc.
ISSN: 0277-0903 print / 1532-4303 onlineDOI: 10.3109/02770903.2011.580810 LETTER TO THE EDITOR
Treatment of Acute Asthma
Capital Allergy & Respiratory Disease Center Only 35.4% (N = 35) of subjects could reliably perform Wilkinson et al. (1) recently compared racemic albuterol spirometry. There is no mention of how many subjects in (RAC) 7.5 mg/h to levalbuterol (LEV) 3.75 mg/h each group could perform spirometry. Furthermore, the in continuous nebulization for the treatment of acute AU rates for the second nebulizer treatment are incorrect.
pediatric asthma exacerbations. The trial duration was Percentages are based on all intent to treat subjects though limited to 2 hours. The LEV group had significantly only slightly more than half of the subjects required higher rate of controller medication use (ICS, LTRA, a second nebulizer treatment. Hospital admissions were LABA) at baseline suggesting they are likely more numerically higher in the RAC group; however, they severe asthmatics. This could indicate they have more were not statistically significant. This correlates with fixed obstruction from advanced disease and are less prior studies where LEV demonstrated reduced hospital responsive to therapy. Discharged patients had more admissions (3). To my knowledge, no studies have shown severe asthma on presentation. This allows more room increases in admissions with LEV. Lastly, the author for improvement in the racemic group versus the LEV concludes that, “when the body of literature as a whole group. No adjustments were made for differences in is reviewed” LEV does not have any clear advantages baseline severity on any endpoints. Patients who could over RAC. I do not understand the basis for this not be consented within 15 minutes or less received RAC 2.5 mg per standing orders. The number of children who received this dose prior to randomization is notreported. This could allow subjects to be more responsive to albuterol and therefore makes identification difficult The author reports no conflicts of interest. The author to interpret. Additionally, it should be pointed out that alone is responsible for the content and writing of the subjects who received RAC will also have elevations of the S-albuterol isomer, which in some studies hasdemonstrated blunted response in FEV1 improvement (2).
Another concern is that the drugs were stored in syringes, J Asthma Downloaded from informahealthcare.com by 65.98.222.114 on 05/18/11 which is not recommended by the manufacturer of LEVas this increases the possibility of contamination and 1. Wilkinson M, Bulloch B, Garcia-Filion P, Keahey, L. Efficacy of racemic degradation from prolonged light exposure or temperature albuterol versus levalbuterol used as a continuous nebulization for thetreatment of acute asthma exacerbations: a randomized, double-blind, extremes. Patients were given ipratropium in the first clinical trial. Journal of Asthma 2011; 48:188–193.
hour. Analysis of ipratropium used in acute shedding 2. Nowak R, Emerman C, Hanrahan JP, Parsey MV, Hanania NA, Claus shows that the drug tends to provide a greater benefit to R, Schaefer K, Baumgartner RA; XOPENEX Acute Severe Asthma more severe subjects versus mild to moderate subjects.
Study Group. A comparison of levalbuterol with racemic albuterol in the This could allow the racemic group, which were more treatment of acute severe asthma exacerbations in adults. The AmericanJournal of Emergency Medicine 2006; 24:259–267.
severe at baseline, to have an advantage in performance 3. Carl JC, Myers TR, Kirchner HL, Kercsmar CM. Comparison of racemic compared with the LEV group. The primary efficacy albuterol and levalbuterol for the treatment of acute asthma. Journal of endpoint of this study was the improvement in FEV1.
∗Corresponding author: Bradley Chipps M.D.; E-mail: bchipps@capitalallergy.com

Source: http://www.capitalallergy.com/pdfs/chipps/81.pdf