The Cardiac Side Effects of Levalbuterol versus Albuterol in Pediatric Patients Presenting with Acute Asthma Attacks: A Systematic Review and Meta-Analysis

Abstract

Aims: Beta-2 agonists are the standard of care for asthmatic patients. Racemic albuterol and levalbuterol are two of the most commonly used bronchodilators of this category. Although their efficacy has been tested excessively, their effects on heart rate remain debatable by many conflicting articles in the medical literature. This review aims to summarize all available data in the literature concerning the effects of Racemic Albuterol versus Levalbuterol on heart rate in asthmatic children. Methods and Results: Our search covered five different databases: PubMed, SCOPUS, Wiley Online Library, Web of Science, and Cochrane Library. We included clinical trials investigating heart rate in asthmatic pediatric patients; either as a primary or secondary outcome. The primary outcome was heart rate changes. Secondary outcomes were respiratory rate, FEV1 peak percent changes, potassium serum levels, SpO2 peak changes, asthma score, and adverse effects. Eight clinical trials were included; seven of them were eligible for meta-analysis. In a dosing ratio of levalbuterol: albuterol =1:4, levalbuterol showed better outcomes on heart rate changes when compared with racemic albuterol (mean difference=-5.97, p=0.02). However, this difference was dose-dependent as it vanished with equivalent dosing of levalbuterol: albuterol =1:2. Levalbuterol also had a better effect on FEV1 changes (mean difference=3.72, p=0.003). However, there was no statistically significant difference between the two drugs regarding changes in respiratory rate, SpO2 , asthma score ,or adverse effects. Conclusion: Levalbuterol and racemic albuterol have almost the same effect on heart rate in asthmatic children when they are used in equivalent dosing (levalbuterol: albuterol =1:2).