studious mood objectives: To compare clinical efficacy.

studious mood objectives: To compare clinical efficacy, patient issues and medical costs in hospitalized patients treated with levalbuterol to those treated with racemic albuterol.

Design: Retrospective chart review.

Setting: A 180-bed community hospital.

Patients: Patients admitted to Halifax Regional Hospital with a diagnosis digest for COPD or asthma from July 1 to December 31 1998 and from July 1 to December 31 1999 were eligible. In 1998 125 patients were treated with nebulized racemic albuterol (25 mg q4h) In 1999 109 patients were treated with levalbuterol (125 mg q8h)

Measurements and results: Clinical efficacy was evaluated through the number of nebulizer treatments, improvement in symptoms and objective clinical findings, the detail of hospital stay, and hospital discharge disposition. Medication and total hospital charges were calculated based on R main division listings and Medicare reimbursement rates. Levalbuterol-treated patients required significantly fewer treatments with [beta]-agonists (mean [+ or -] SD] number of treatments, 190 [+ or -] 127 v 308 [+ or -] 240; p < 0001) and ipratropium bromide (mean number of treatments, 94 [+ or -] 115 v 232 [+ or -] 251; p < 0001) than did racemic albuterol-treated patients. The mean continuance of hospital stay in the levalbuterol form into groups was almost 1 day les than that in the racemic albuterol form into groups (4.7 [+ or -] 29 v 56 [+ or -] 42 days, respectively; p < 0058) Significantly more patients were readmitted to the hospital within 30 days in the racemic albuterol arrange compared with the levalbuterol dispose (16.4% vs 5.7%, respectively; p = 001) The mean total richness of nebulizer therapy was significantly greater for patients receiving racemic albuterol than for those receiving for levalbuterol ($112 [+ or -] 101 v $61 [+ or -] 43 respectively; p < 0001) The mean total hospital preciousnesss per patient were less for levalbuterol compared with racemic albuterol ($2756 [+ or -] 2079 v $3225 [+ or -] 2714 respectively; p = 011) Regression analysis controlling for diagnosis, baseline FE[Vsub1] and ipratropium use indicated that levalbuterol was associated with a length-of-stay savings of 091 days (p = 0015) a total require to be paid [i]or[/i] undergone savings of $556 (p = 0013) and a decrease in the likelihood of hospital readmission of 67% (p = 0056)

Conclusion: Compared with patients treated with racemic albuterol, those treated with levalbuterol required les medication, had shorter fulnesss of hospital stay, had decreased require to be paid [i]or[/i] undergones for nebulizer therapy and hospitalization, and appeared to have a more defered therapeutic benefit. These findings support using levalbuterol as first-line therapy for hospitalized adults with COPD or asthma.

clew words: asthma; COPD; efficacy; levalbuterol; nebulizer; pharmacoeconomics; racemic albuterol; respiratory therapy

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Since its approval in 1982 the [[beta].sub.2]-agonist racemic albuterol has been a mainstay in treating the bronchial flat muscle spasm associated with reversible obstructive airway diseases of that kind as COPD and asthma. (1) With regular use, a progressive decline in the bronchoprotective efficacy of racemic albuterol, leading to a decreased interval between doses and diminished bronchodilation, has been observ (23) Up to 8% of patients who receive racemic albuterol via nebulization actually lay open paradoxical bronchospasm, a life-threatening condition. (45)

single reason for this decline in efficacy could be related to the composition of racemic albuterol. With common exception (levalbuterol), all marketed forms of [beta]-agonists are racemic mixtures that are compos of a 50:50 ratio of (R)-isomers and (S)-isomers. (R)-albuterol (hereafter referr to as levalbuterol) is the therapeutically active bronchodilator. circulating evidence indicates that (S)-albuterol is devoid of any bronchodilatory activity. (6) Rather, (S)-albuterol increases intracellular calcium in airway polished muscle cells in vitro, which aids smooth muscle contraction and withstands bronchodilation. (7,8) This also outcomes in the increased bronchial reactivity of human airway glossy muscle in vitro. (9) In guinea pigs, (S)-albuterol enhances airway hyperresponsiveness to nonspecific spasmogens. (9-12) (S)-albuterol also may recruit eosinophils to the airway and may stir up their activation. (13,14) Clinically, (S)-albuterol promot greater hypersensitivity and increased methacholine-induced bronchospasm in patients with moderately morose asthma. (6)

In contrast, levalbuterol is the active constituent of racemic albuterol that, when administered as the single isomer, avoids all of the potentially detrimental drifts of (S)-albuterol. In asthmatic patients, treatment with levalbuterol decreased hypersensitivity to methacholine to a greater standing and with a longer duration of action than does treatment with racemic albuterol. (615) In outpatient studies, (16-18) asthma patients who were treated with levalbuterol experienced a significantly greater increase in FE[Vsub1] a longer duration of action, and fewer side meanings In the emergency department, levalbuterol improved pulmonary function significantly more than racemic albuterol (19) and significantly decreased the number of hospitalizations compared to racemic albuterol. (20) These data hint that the (S)-albuterol within racemic albuterol limits the beneficial pharmacologic activity of levalbuterol.

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