Levalbuterol versus albuterol for acute asthma: A systematic review and meta-analysis

Pulmonary Pharmacology and Therapeutics

Volumn 26, Issue 2, 2013, Pages 239-248

  Jat, Kana Ram ^a   Khairwa, Anju ^b  

^a GOVERNMENT MEDICAL COLLEGE AND HOSPITAL   (India)

^b POSTGRADUATE INSTITUTE OF MEDICAL EDUCATION AND RESEARCH   (India)

Author keywords

Airways; Beta2 agonists; Bronchial asthma; Forced expiratory volume; Randomized trials; Safety

Indexed keywords

IPRATROPIUM BROMIDE; LEVALBUTEROL; SALBUTAMOL;

ARTICLE; ARTIFICIAL VENTILATION; ASTHMA; BREATHING RATE; DISEASE SEVERITY; DRUG EFFICACY; DRUG INDUCED HEADACHE; DRUG SAFETY; FORCED EXPIRATORY VOLUME; HOSPITAL ADMISSION; HOSPITALIZATION; HUMAN; LENGTH OF STAY; META ANALYSIS; NAUSEA AND VOMITING; OUTCOME ASSESSMENT; OXYGEN SATURATION; PEAK EXPIRATORY FLOW; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL (TOPIC); SPIROMETRY; SYSTEMATIC REVIEW; TACHYCARDIA; TREMOR;

ACUTE DISEASE; ALBUTEROL; ASTHMA; BRONCHODILATOR AGENTS; FORCED EXPIRATORY VOLUME; HUMANS; STEREOISOMERISM;

EID: 84874574717     PISSN: 10945539     EISSN: 15229629     Source Type: Journal    
DOI: 10.1016/j.pupt.2012.11.003     Document Type: Article

References (33)

1. Masoli M., Fabian D., Holt S., Beasley R. The global burden of asthma: executive summary of the GINA dissemination committee report. Allergy 2004, 59:469-478.
2. Masoli M, Fabian D, Holt S, Beasley R. The global burden of asthma report, Global initiative for asthma (GINA). Available from: [accessed 15.07.2011]. http://www.ginasthma.org/pdf/GINABurdenReport.pdf.
3. CDC Asthma mortality and hospitalization among children and young adults - United States, 1980-1993. Morbidity Mortality Wkly Rep MMWR 1996, 45:350-353.
4. Akinbami L.J. The state of childhood asthma, United States, 1980-2005. Advance data from Vital and Health Statistics 2006, No. 381, Available at:, [accessed 15.07.2011]. http://www.cdc.gov/nchs/data/ad/ad381.pdf.
5. National Heart, Lung, and Blood Institute.National Asthma Education and Prevention Program Expert panel report 3: guidelines for the diagnosis and management of asthma 2007, Available from:, [accessed 15.07.2011]. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf.
6. Global strategy for Asthma management and prevention Available from:, [accessed 15.07.2011]. http://www.ginasthma.org/pdf/GINA_Report_2010.pdf.
7. British guideline on management of asthma A national clinical guideline 2011, Available from:, [accessed 15.07.2011]. http://www.sign.ac.uk/pdf/sign101.pdf.
8. Page C.P., Morley J. Contrasting properties of albuterol stereoisomers. J Allergy Clin Immunol 1999, 104:S31-S41.
9. Bakale R.P., Wald S.A., Butler H.T., Gao Y., Hong Y., Nie X., et al. Albuterol. A pharmaceutical chemistry review of R-, S-, and RS albuterol. Clin Rev Allergy Immunol 1996, 14:7-35.
10. Spitzer W.O., Suissa S., Ernst P., Horwitz R.I., Habbick B., Cockcroft D., et al. The use of β2-agonists and the risk of death and near death from asthma. N Engl J Med 1992, 326:501-506.
11. Sears M.R., Taylor D.R., Print C.G., Lake D.C., Li Q.Q., Flannery E.M., et al. Regular inhaled beta-agonist treatment in bronchial asthma. Lancet 1990, 336:1391-1396.
12. Perrin-Fayolle M. Salbutamol in the treatment of asthma. Lancet 1995, 346:1101.
13. Penn R.B., Frielle T., McCullough J.R., Aberg G., Benovic J.L. Comparison of R-, S-, and RS-albuterol interaction with human β1- and β2-adrenergic receptors. Clin Rev Allergy Immunol 1996, 14:37-45.
14. Baramki D., Koester J., Anderson A.J., Borish L. Modulation of T-cell function by (R)- and (S)-isomers of albuterol: anti-inflammatory influences of (R)-isomers are negated in the presence of the (S)-isomer. J Allergy Clin Immunol 2002, 109:449-454.
15. Cho S.H., Hartleroad J.Y., Oh C.K. (S)-albuterol increases the production of histamine and IL-4 in mast cells. Int Arch Allergy Immunol 2001, 124:478-484.
16. Templeton A.G., Chapman I.D., Chilvers E.R., Morley J., Handley D.A. Effects of S-salbutamol on human isolated bronchus. Pulm Pharmacol Ther 1998, 11:1-6.
17. Mitra S., Ugur M., Ugur O., Goodman H.M., McCullough J.R., Yamaguchi H. (S)-Albuterol increases intracellular free calcium by muscarinic receptor activation and a phospholipase C-dependent mechanism in airway smooth muscle. Mol Pharmacol 1998, 53:347-354.
18. Dhand R., Goode M., Reid R., Fink J.B., Fahey P.J., Tobin M.J. Preferential pulmonary retention of (S)-albuterol after inhalation of racemic albuterol. Am J Respir Crit Care Med 1999, 160:1136-1141.
19. Gumbhir-Shah K., Kellerman D.J., DeGraw S., Koch P., Jusko W.J. Pharmacokinetics and pharmacodynamics of cumulative single doses of inhaled salbutamol enantiomers in asthmatic subjects. Pulm Pharmacol Ther 1999, 12:353-362.
20. Liberati A., Altman D.G., Tetzlaff J., Mulrow C., Gøtzsche P.C., Ioannidis J.P.A., et al. The PRISMA statement for reporting systematic reviews and meta-analyses of trials that evaluate health care interventions: explanation and elaboration. Ann Intern Med 2009, 151:W65-W94.
21. Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011) 2011, Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included trials, The Cochrane Collaboration, Available from:, [accessed 15.08.2011]. http://www.cochrane-handbook.org, J.P.T. Higgins, S. Green (Eds.).
22. Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011) 2011, Higgins JPT, Deeks JJ (editors). Chapter 7: Selecting trials and collecting data, The Cochrane Collaboration, Available from:, [accessed 15.08.2011]. http://www.cochrane-handbook.org, J.P.T. Higgins, S. Green (Eds.).
23. Review manager (RevMan) [computer program]. Version 5.1 2011, The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Available from:, [accessed 18.05.2011]. http://ims.cochrane.org/revman/download.
24. Wilkinson M., Bulloch B., Garcia-Filion P., Keahey L. Efficacy of racemic albuterol versus levalbuterol used as a continuous nebulization for the treatment of acute asthma exacerbations: a randomized, double-blind, clinical trial. J Asthma 2011, 48:188-193.
25. Punj A., Prakash A., Bhasin A. Levosalbutamol vs racemic salbutamol in the treatment of acute exacerbation of asthma. Indian J Pediatr 2009, 76:1131-1135.
26. Andrews T., McGintee E., Mittal M.K., Tyler L., Chew A., Zhang X., et al. High-dose continuous nebulized levalbuterol for pediatric status asthmaticus: a randomized trial. J Pediatr 2009, 155:205-210.
27. Nowak R., Emerman C., Hanrahan J.P., Parsey M.V., Hanania N.A., Claus R., et al. A comparison of levalbuterol with racemic albuterol in the treatment of acute severe asthma exacerbations in adults. Am J Emerg Med 2006, 24:259-267. XOPENEX Acute Severe Asthma Trial Group.
28. Hardasmalani M.D., DeBari V., Bithoney W.G., Gold N. Levalbuterol versus racemic albuterol in the treatment of acute exacerbation of asthma in children. Pediatr Emerg Care 2005, 21:415-419.
29. Qureshi F., Zaritsky A., Welch C., Meadows T., Burke B.L. Clinical efficacy of racemic albuterol versus levalbuterol for the treatment of acute pediatric asthma. Ann Emerg Med 2005, 46:29-36.
30. Carl J.C., Myers T.R., Kirchner H.L., Kercsmar C.M. Comparison of racemic albuterol and levalbuterol for treatment of acute asthma. J Pediatr 2003, 143:731-736.
31. Sethuraman U., Stewart G.M., Rosenberg N.M. Comparison of levalbuterol versus albuterol in children with mild to moderate exacerbation of asthma in the emergency department. Pediatr Emerg Care 2001, 17:317. [abstract].
32. Haider D. Levalbuterol (lev) affords superior health and cost benefit over racemic albuterol (rac) in the emergency department(ED). Respir Care 2001, 46:1081.
33. Brozek J., Oxman A., Schünemann H. GRADEpro [computer program]. Version 3.2 for Windows 2008, Available from:, [accessed 18.05.2011]. http://ims.cochrane.org/revman/other-resources/gradepro/download.