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An Evaluation of Nebulized Levalbuterol in Stable COPD^*

^* From the Section of Pulmonary and Critical Care Medicine (Drs. Lahiri and ZuWallack) and Department of Pharmacy (Mr. Vitale), St. Francis Hospital & Medical Center, Hartford; and Division of Pulmonary and Critical Care Medicine (Dr. Datta), University of Connecticut Health Center, Farmington, CT.

Correspondence to: Richard ZuWallack, MD, FCCP, Section of Pulmonary and Critical Care Medicine, St. Francis Hospital & Medical Center, 114 Woodland St, Hartford, CT 06105; e-mail: rzuwalla{at}stfranciscare.org

Background: Levalbuterol, the R-isomer of albuterol, has advantages over racemic albuterol in asthma; however, the effectiveness of this ß-agonist in COPD has received little attention.

Objectives: To evaluate the effectiveness of a single dose of nebulized levalbuterol in COPD.

Design: A randomized, double-blind, placebo-controlled trial comparing nebulized levalbuterol to racemic albuterol, combined racemic albuterol and ipratropium, and placebo.

Patients: Thirty patients with stable COPD (FEV₁ between 45% and 70% of predicted) were studied.

Methods: After withholding usual bronchodilator medications for appropriate washout periods, patients were randomized on separate visits to receive single doses of each the following nebulized bronchodilator medications: (1) levalbuterol, 1.25 mg; (2) racemic albuterol, 2.5 mg; (3) combined racemic albuterol, 2.5 mg, and ipratropium, 0.5 mg; or (4) placebo. FEV₁, FVC, pulse rate, and oxygen saturation were measured at baseline, 0.5 h following nebulization, and hourly for 6 h. Hand tremor, using a 7-point scale, was measured at baseline, 0.5 h, 1 h, and 2 h. Treatment-placebo differences were analyzed using repeated-measures analysis of variance and least-squares means.

Results: The mean age (± SD) of patients was 69 ± 15 years. Mean FEV₁ was 1.15 ± 0.49 L. By 0.5 h following study drug administration, all three nebulized bronchodilator treatments led to similar, significant improvements in FEV₁ compared to placebo. These effects persisted at 1 h and 2 h for all three treatments; however, by 3 h, only the combined albuterol/ipratropium group had a mean change in FEV₁ significantly greater than placebo. There were no significant differences between bronchodilator groups at any time period. A mild increase in pulse rate was observed in all treatment groups. There were no significant treatment-placebo differences in oxygen saturation or hand tremor.

Conclusion: For single-dose, as-needed use in COPD, there appears to be no advantage in using levalbuterol over conventional nebulized bronchodilators.

Key Words: bronchodilator • COPD • levalbuterol