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

Jat, Kana Ram; Khairwa, Anju

doi:10.1016/j.pupt.2012.11.003

Cited by 58 publications

(35 citation statements)

References 23 publications

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“…A meta-analysis of clinical studies evaluating levalbuterol versus albuterol for the treatment of acute asthma patients (pediatric and adult) concluded that levalbuterol is not superior to albuterol in terms of safety or efficacy. 33 Studies performed by Donohue and colleagues 34 and Nowak and colleagues 35 concluded that levalbuterol was a more effective bronchodilator in the adult population on a milligram-per-milligram basis. While no significant changes in forced expiratory volume (FEV 1 ), length of hospital stay, or relapse rates with levalbuterol use were seen in the study of Donohue et al, 34 leval buterol decreased the total and scheduled nebulizations required per patient stay, without a significant change in the use of rescue nebulizations; this finding was expected because, per the study design, patients in the levalbuterol group were scheduled to receive fewer doses than those treated with albuterol.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and treatment cost comparison of levalbuterol versus albuterol in hospitalized adults with chronic obstructive pulmonary disease or asthma

Brunetti

Poiani

Dhanaliwala

et al. 2015

American Journal of Health-System Pharmacy

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes and treatment cost comparison of levalbuterol versus albuterol in hospitalized adults with chronic obstructive pulmonary disease or asthma

Brunetti

Poiani

Dhanaliwala

et al. 2015

American Journal of Health-System Pharmacy

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“…All SRs searched MEDLINE, 11 searched CENTRAL (17,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28), and nine searched EMBASE (17)(18)(19)(20)(21)(22)(25)(26)(27)(28). Four or less searched AMED (17,19,20,22), PsycINFO (17,19,20,22), PubMed (23,25), and clinicaltrials.gov (19), and all Cochrane SRs searched the Cochrane Airways Group Specialized Register of Trials.…”

Section: Search Methods Used In the Included Srsmentioning

confidence: 99%

“…Four or less searched AMED (17,19,20,22), PsycINFO (17,19,20,22), PubMed (23,25), and clinicaltrials.gov (19), and all Cochrane SRs searched the Cochrane Airways Group Specialized Register of Trials. Common additional sources searched included the following: handsearching reference lists, journals, meeting abstracts, and/or conference proceedings (17)(18)(19)(20)(21)(22)(24)(25)(26)(27)(28)(29); and contacting authors, clinicians, collaborators, and/or drug companies (17-19, 21, 22, 24, 27, 29).…”

Section: Search Methods Used In the Included Srsmentioning

confidence: 99%

“…Eleven SRs provided data on hospital admission (17-20, 22-25, 27-29), four provided data on ED LOS (17,22,24,29), and no SRs provided data on ICU admission with or without ventilator support. Eight SRs provided data on vital signs (17,18,21,23,24,26,28,29), eight provided data on clinical severity scores (18,20,(22)(23)(24)(27)(28)(29), and nine provided data on adverse effects (17-20, 22, 24, 26, 27, 29). Nine SRs also provided data on pulmonary function (17-20, 22, 24, 25, 27, 29).…”

Section: Outcome Measuresmentioning

confidence: 99%

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Inhaled short-acting bronchodilators for managing emergency childhood asthma: an overview of reviews

Pollock

Sinha

Hartling

et al. 2016

Allergy

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International guidelines provide conflicting recommendations on how to use bronchodilators to manage childhood acute wheezing conditions in the emergency department (ED), and there is variation within and among countries in how these conditions are managed. This may be reflective of uncertainty about the evidence. This overview of systematic reviews (SRs) aimed to synthesize, appraise, and present all SR evidence on the efficacy and safety of inhaled short-acting bronchodilators to treat asthma and wheeze exacerbations in children 0-18 years presenting to the ED. Searching, review selection, data extraction and analysis, and quality assessments were conducted using methods recommended by The Cochrane Collaboration. Thirteen SRs containing 56 relevant trials and 5526 patients were included. Results demonstrate the efficacy of short-acting beta-agonist (SABA) delivered by metered-dose inhaler as first-line therapy for younger and older children (hospital admission decreased by 44% in younger children, and ED length of stay decreased by 33 min in older children). Short-acting anticholinergic (SAAC) should be added to SABA for older children in severe cases (hospital admission decreased by 27% and 74% when compared to SABA and SAAC alone, respectively). Continuous nebulization, addition of magnesium sulfate to SABA, and levosalbutamol compared to salbutamol cannot be recommended in routine practice.Acute wheeze in children is one of the most common reasons for presentation to the emergency departments (ED) (1). In school-aged children, acute wheeze usually signifies underlying asthma, while in preschool children this sign may be the result of either asthma or viral-induced wheeze with distinct phenotypes and underlying mechanisms. In these age groups, regardless of the underlying pathology, exacerbations of recurrent wheeze and dyspnoea are largely caused by bronchoconstriction of the small airways. Although most children improve with bronchodilator therapy, many require hospital admission, and others may even require admission to critical or intensive care units. It is important, therefore, that children with wheeze and dyspnoea are treated promptly and appropriately in the ED to reduce symptoms and respiratory distress, mitigate hospital admission, and prevent respiratory failure. Across the UK and many other countries, there is a 10-fold difference in rates of hospital admission for acute asthma in children (2).Although the reasons for this are complex, one factor may be variations among EDs in the management of pediatric asthma, which have recently been described for key interventions such as inhaled bronchodilators (3).The three most common groups of inhaled bronchodilators used to treat acute asthma and wheeze in EDs are short-acting beta-agonists (SABA) such as salbutamol (albuterol), levosalbutamol (levalbuterol), and adrenaline (epinephrine); short-acting anticholinergics (SAACs) such as ipratropium bromide; and, more recently, a third category of muscle relaxants comprising magnesium sulfate (MgSO ...

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“…Studies comparing the effect of racemic albuterol to levalbuterol in intensive care patients and pediatric cardiology patients demonstrated small but similar increases in heart rates with both SABAs [28,29]. A recent systematic review and meta-analysis examining levalbuterol and albuterol in acute asthma failed to demonstrate improved efficacy or safety with levalbuterol [30]. SABAs can also stimulate liver glycogenolysis which can result in hyperglycemia.…”

Section: Short-acting Beta 2 Agonists (Sabas)mentioning

confidence: 99%

The Acute Management of Asthma

Albertson

Sutter

Chan

2014

Clinic Rev Allerg Immunol

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Patients presenting to the emergency department (ED) or clinic with acute exacerbation of asthma (AEA) can be very challenging varying in both severity and response to therapy. High-dose, frequent or continuous nebulized short-acting beta2 agonist (SABA) therapy that can be combined with a short-acting muscarinic antagonist (SAMA) is the backbone of treatment. When patients do not rapidly clinically respond to SABA/SAMA inhalation, the early use of oral or parenteral corticosteroids should be considered and has been shown to impact the immediate need for ICU admission or even the need for hospital admission. Adjunctive therapies such as the use of intravenous magnesium and helium/oxygen combination gas for inhalation and for driving a nebulizer to deliver a SABA and or SAMA should be considered and are best used early in the treatment plan if they are likely to impact the patients' clinical course. The use of other agents such as theophylline, leukotriene modifiers, inhaled corticosteroids, long-acting beta2 agonist, and long-acting muscarinic antagonist currently does not play a major role in the immediate treatment of AEA in the clinic or the ED but is an important therapeutic option for physicians to be aware of and to consider initiating at the time of discharge from clinic, hospital, or ED to reduce later clinical worsening and readmission to the ED and hospital. A comprehensive summary is provided of the currently available respiratory pharmaceuticals approved for asthma and other airway syndromes. Clinicians must be prepared to use the entire spectrum of medications available for the treatment of acute asthma exacerbations and the agents that should be initiated to prevent worsening or additional exacerbations. They need to be familiar with the major potential drug toxicities associated with their use.

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

Cited by 58 publications

References 23 publications

Clinical outcomes and treatment cost comparison of levalbuterol versus albuterol in hospitalized adults with chronic obstructive pulmonary disease or asthma

Clinical outcomes and treatment cost comparison of levalbuterol versus albuterol in hospitalized adults with chronic obstructive pulmonary disease or asthma

Inhaled short-acting bronchodilators for managing emergency childhood asthma: an overview of reviews

The Acute Management of Asthma

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