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American Journal of Emergency Medicine (2005) 23, 842 – 847

www.elsevier.com/locate/ajem

Original Contributions

Comparison of racemic albuterol and levalbuterol in the treatment of acute asthma in the EDB,BB
David M. Schreck MD, MSa,b,c,*, Stephen Babin RNd
a

Summit Medical Group, Summit, NJ 07901, USA Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA c Emergency MedicalAssociates, Livingston, NJ 07039, USA d Muhlenberg Regional Medical Center, Plainfield, NJ 07060, USA
b

Accepted 8 April 2005

Abstract Background: Acute asthma is often treated with racemic albuterol, a 1:1 mixture of (R)-albuterol and (S)-albuterol. Levalbuterol is the single-isomer agent comprised (R)-albuterol, an active bronchodilator, without any effects of (S)-albuterol. Objective:To compare emergency department (ED) admission rates of patients presenting with acute asthma who were treated with either racemic albuterol or levalbuterol. Setting: Suburban community teaching hospital. Design: Retrospective observational case review. Methods: Emergency department patients presenting with acute asthma at 2 different sites were reviewed over 9- and 3-month consecutive periods.Outcome measures included ED hospital admission rate, length of stay, arrival acuity, and treatment costs. Patients were excluded if younger than 1 year or if no treatment of acute asthma was rendered. Results: Of the initial 736 consecutive cases, significantly fewer admissions (4.7% vs 15.1%, respectively; P = .0016) were observed in the levalbuterol vs racemic albuterol group. Of the subsequent186 consecutive cases, significantly fewer admissions were also observed (13.8% vs 28.9%, respectively; P = .021) in the levalbuterol vs racemic albuterol group. Treatment costs were lower with levalbuterol mainly because of a decrease in hospital admissions. Conclusion: Levalbuterol treatment in the ED for patients with acute asthma resulted in higher patient discharge rates and may be acost-effective alternative to racemic albuterol. D 2005 Elsevier Inc. All rights reserved.

Presented in part at the American College of Emergency Physicians Research Forum, October 15 to 18, 2001, Chicago, Ill; the National Association of EMS Physicians Annual Scientific Sessions, January 16, 2003, Panama City, Fla; and the Society of Critical Care Medicine 33rd Critical Care Congress, Orlando, Fla,February 22, 2004. B This investigation was not funded by any pharmaceutical company. Partial funding was obtained from Emergency Medical Associates Research Foundation. BB Dr Schreck has provided post-study consultative services to the manufacturer of levalbuterol, Sepracor, Inc, by serving on the Sepracor Speakers Bureau. T Corresponding author. 80 Division Ave, Summit, NJ 07901, USA. Tel.: +1 973740 0607; fax: +1 908 522 0596. E-mail address: dschreck@comcast.net (D.M. Schreck). 0735-6757/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.ajem.2005.04.003

Racemic albuterol versus levalbuterol in the treatment of acute asthma in the ED

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1. Introduction
Asthma is one of the most common illnesses treated in the emergency department (ED) setting. It isreported that nearly 15 million Americans have asthma, and the more than 2 million annual ED visits result in costs in excess of $6 billion with hospitalizations accounting for the largest portion of these costs [1- 4]. In the United States from 1992 to 1999, the absolute number and rate of ED visits for asthma increased by 36% and 29%, respectively [4]. An evaluation of 1 448 555 consecutivepatients presenting to 15 EDs in northern New Jersey from 1997 to 1999 demonstrated an increasing number of asthma visits (Fig. 1). In addition, an increasing proportion of asthmarelated hospital admissions from the ED was also reported. In the calendar year 1999, it was shown that 2.7% of all ED admissions were due to acute asthma and the average acute asthma admission rate from 1997 to 1999 was...
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