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Annals of Allergy, Asthma & Immunology... Dec 2003
Topics: Adrenergic beta-Agonists; Albuterol; Asthma; Bronchodilator Agents; Humans
PubMed: 14700446
DOI: 10.1016/S1081-1206(10)61541-4 -
The American Journal of Geriatric... Dec 2010The evidence for the benefits of branded levalbuterol over generic albuterol in patients with chronic obstructive pulmonary disease (COPD) is inconclusive. However,... (Comparative Study)
Comparative Study
BACKGROUND
The evidence for the benefits of branded levalbuterol over generic albuterol in patients with chronic obstructive pulmonary disease (COPD) is inconclusive. However, there are significant cost differences between these products.
OBJECTIVES
This study examined use and spending on albuterol and levalbuterol in a nationally representative sample of Medicare beneficiaries with COPD enrolled in Part D in 2006. It also examined differences in patient characteristics and use of other COPD drugs among recipients of these 2 short-acting β-agonists.
METHODS
Data were obtained from the 5% Medicare files for 2005-2006 linked to the 2006 Medicare Part D files. The sample consisted of all fee-for-service beneficiaries with COPD enrolled in stand-alone Part D plans in 2006. Patient characteristics and other COPD medication use were compared across albuterol-only users, levalbuterol-only users, and users of both albuterol and levalbuterol. Multinomial logistic regressions were used to identify factors independently associated with levalbuterol use.
RESULTS
There were 5.5 times more albuterol users than levalbuterol users in 2006; however, mean annual spending on levalbuterol was 18.6 times higher per user in 2006 than spending on albuterol ($1876 vs $101 per user, respectively). Levalbuterol-only users were more likely to be older than albuterol-only users (mean age: 71.5 vs 68.7 years; P < 0.05), as well as sicker (mean prescription drug hierarchical condition category score: 1.72 vs 1.55; P < 0.05) and residing in the South (67.9% vs 41.6%; P < 0.05). Levalbuterol-only users were more likely to use nebulizer forms covered under Part B than inhaler forms covered under Part D (78.6% vs 26.8%, respectively; P < 0.05), whereas albuterol-only users were more likely to use inhaler forms covered under Part D than nebulizer forms covered under Part B (82.2% vs 33.0%, respectively; P < 0.05).
CONCLUSIONS
In this sample of Medicare beneficiaries with COPD enrolled in Part D, mean annual spending in 2006 was significantly higher for levalbuterol than for albuterol. The differences between levalbuterol and albuterol users in terms of patient characteristics, geographic region, and drug formulation/device type, coupled with the inconclusive evidence for efficacy differences in the literature, highlight the need for further comparative clinical and cost-effectiveness studies of these agents.
Topics: Adrenergic beta-2 Receptor Agonists; Age Factors; Aged; Aged, 80 and over; Albuterol; Bronchodilator Agents; Drug Costs; Female; Health Expenditures; Humans; Logistic Models; Male; Medicare Part D; Middle Aged; Nebulizers and Vaporizers; Pulmonary Disease, Chronic Obstructive; Stereoisomerism; United States
PubMed: 21356506
DOI: 10.1016/S1543-5946(10)80006-6 -
American Family Physician May 2008
Topics: Acute Disease; Albuterol; Asthma; Bronchodilator Agents; Child; Humans
PubMed: 18540484
DOI: No ID Found -
Pediatric Pulmonology Apr 2017Racemic albuterol and levalbuterol are used to treat acute episodes of asthma. The main objective of this study was to compare levalbuterol therapy to albuterol therapy...
OBJECTIVE
Racemic albuterol and levalbuterol are used to treat acute episodes of asthma. The main objective of this study was to compare levalbuterol therapy to albuterol therapy on incidence rates of subsequent emergency department (ED) visits and hospitalizations.
METHOD
We conducted a retrospective cohort study of asthmatic children who had pharmacy refills for levalbuterol/albuterol in the South Carolina Medicaid database in 2002-2011. Children receiving levalbuterol were matched to those receiving albuterol using propensity score matching technique. For ED visits and separately for hospitalizations, multivariable negative binomial regression was used to estimate the two group-specific incidence rates and the incidence rate ratio (IRR).
RESULTS
A total of 8,172 asthmatic patients aged 2-18 years were identified in the South Carolina Medicaid database. During the 12-month follow-up period, the levalbuterol group had fewer asthma-related ED visits and hospitalizations: 939 (11.49%) children had asthma-related ED visits (levalbuterol: 8.76%; albuterol: 14.21%), and 89 (1.09%) children had asthma-related hospitalizations (levalbuterol: 1.07%; albuterol: 1.12%). Comparing the levalbuterol group to the albuterol group, the adjusted IRR estimate was 0.57 (95% confidence interval [CI], 0.49-0.65) for of asthma-related ED visits, and 0.93 (95%CI, 0.99-1.63) for hospitalizations. Children filling levalbuterol also had a lower IRR of all-cause ED visit (0.88; 95%CI, 0.82-0.95), but similar IRR of all-cause hospitalizations (1.08; 95%CI, 0.82-1.42).
CONCLUSION
This observational study of children aged 2-18 demonstrated levalbuterol prescription fills were associated with reduced ED visits, but not hospitalizations. Additional research may be necessary to assess this association. Pediatr Pulmonol. 2017;52:516-523. © 2016 Wiley Periodicals, Inc.
Topics: Adolescent; Albuterol; Asthma; Bronchodilator Agents; Child; Child, Preschool; Cohort Studies; Emergency Service, Hospital; Female; Hospitalization; Humans; Levalbuterol; Male; Medicaid; Propensity Score; Retrospective Studies; South Carolina; Treatment Outcome; United States
PubMed: 27701831
DOI: 10.1002/ppul.23565 -
Pharmacotherapy Mar 2001A new generation of bronchodilators is being developed for acute asthma management-single-isomer beta-agonists. These drugs consist only of the active bronchodilatory... (Review)
Review
A new generation of bronchodilators is being developed for acute asthma management-single-isomer beta-agonists. These drugs consist only of the active bronchodilatory isomer (eutomer); they do not have the inactive and potentially harmful isomer (distomer) that is present in marketed racemic beta-agonists. Clinical studies comparing the effectiveness of (R)-albuterol (levalbuterol) with racemic albuterol established a strong rationale for using single-isomer beta-agonists in place of the racemic mixture: reduced dosages provide equivalent bronchodilatory effects with fewer beta-mediated side effects. Higher dosages achieve superior bronchodilation in episodes of severe asthma and may reduce costs of emergency department treatment.
Topics: Administration, Inhalation; Adrenergic beta-Agonists; Albuterol; Asthma; Bronchi; Bronchodilator Agents; Ethanolamines; Formoterol Fumarate; Humans
PubMed: 11253864
DOI: 10.1592/phco.21.4.21s.34261 -
The Australian Nurses' Journal. Royal... Nov 1981
Topics: Adult; Albuterol; Child; Female; Humans; Pregnancy
PubMed: 6916597
DOI: No ID Found -
The Journal of Allergy and Clinical... Aug 1999Although racemic albuterol is an effective bronchodilator, regular use has been associated with some loss of bronchodilator potency, decreased protection against... (Comparative Study)
Comparative Study Review
Although racemic albuterol is an effective bronchodilator, regular use has been associated with some loss of bronchodilator potency, decreased protection against bronchoprovocation, increased sensitivity to allergen challenge, and increased sensitivity to some bronchoconstrictor stimuli. In experimental animals racemic albuterol has produced bronchial hyperresponsiveness, which could also be induced by administration of (S)-albuterol. These findings suggest that the pure or homochiral formulation of (R)-albuterol (levalbuterol) might be more effective as a bronchodilator than the racemic form. Single doses of levalbuterol provided more prolonged protection against methacholine challenge than the racemate, whereas (S)-albuterol significantly increased sensitivity to methacholine. In a 4-week study in adults, equivalent amounts of pure levalbuterol provided greater bronchodilation than did similar amounts of levalbuterol given as racemic mixtures. Furthermore, after 4 weeks, the baseline morning FEV(1 ) was lower in those receiving the racemate than in those receiving placebo or levalbuterol. In a single-dose study in children, the same conclusion regarding greater bronchodilation with pure levalbuterol compared with the same amount of levalbuterol in a racemic mixture was confirmed. These studies appear to confirm the greater efficacy of pure levalbuterol over a similar amount in a racemic mixture. This implies a deleterious effect of (S)-albuterol on both the acute bronchodilator response and baseline airway caliber, the exact mechanism of which will require further investigation.
Topics: Adrenergic beta-Agonists; Adult; Albuterol; Asthma; Bronchodilator Agents; Child; Clinical Trials as Topic; Female; Humans; Male; Respiratory Hypersensitivity; Stereoisomerism
PubMed: 10452792
DOI: 10.1016/s0091-6749(99)70277-0 -
Revue de L'infirmiere Feb 1988
Topics: Albuterol; Humans
PubMed: 3153532
DOI: No ID Found -
The American Journal of Emergency... Nov 2005Acute 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,... (Comparative Study)
Comparative Study
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 subsequent 186 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 a cost-effective alternative to racemic albuterol.
Topics: Acute Disease; Adolescent; Adult; Aged; Albuterol; Asthma; Bronchodilator Agents; Child; Child, Preschool; Cost-Benefit Analysis; Emergency Service, Hospital; Female; Health Care Costs; Humans; Male; Middle Aged; Retrospective Studies; Stereoisomerism; Treatment Outcome
PubMed: 16291438
DOI: 10.1016/j.ajem.2005.04.003 -
Journal of Veterinary Internal Medicine Jul 2016The (R)-enantiomer of racemic albuterol (levalbuterol) has bronchodilatory properties whereas the (S)-enantiomer causes adverse effects in human airways, animal models,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The (R)-enantiomer of racemic albuterol (levalbuterol) has bronchodilatory properties whereas the (S)-enantiomer causes adverse effects in human airways, animal models, and isolated equine bronchi. Levalbuterol is commercially available and improves pulmonary function of asthmatic patients with a longer duration of effect than albuterol.
OBJECTIVE
To determine the dose at which inhaled levalbuterol produces maximal bronchodilatory effect (EDmax) and determine its duration of action in recurrent airway obstruction (RAO)-affected horses in comparison to racemic albuterol.
ANIMALS
Nine horses with inducible and reversible RAO.
METHODS
Randomized, crossover trial. Horses were challenged with moldy hay to induce airway obstruction. Horses were treated with nebulized albuterol or levalbuterol chosen randomly. Pulmonary function testing (PFT) was measured before and for up to 3 hours after bronchodilatation challenge. Maximum change in transpulmonary pressure (DPmax ) was measured to assess the dose effect and duration of action of each drug. After a 24 hours washout period, the bronchodilatation challenge was repeated with the second bronchodilator.
RESULTS
The duration of effect was 60 minutes for albuterol and 120 minutes for levalbuterol. The dose of bronchodilator EDmax was not significantly different between albuterol and levalbuterol (EDmax = 125.0 [125-125 μg] and EDmax = 188 [125-188 μg] respectively; P = .068). The magnitude of bronchodilatation was not significantly different between the 2 treatments (61.1 and 59.9% decrease in DPmax for albuterol and levalbuterol respectively; P = .86).
CONCLUSIONS AND CLINICAL IMPORTANCE
Levalbuterol is as effective a bronchodilator as albuterol; although levalbuterol lasts twice as long as albuterol, its duration of action is still too short to make it practical for RAO treatment.
Topics: Albuterol; Animals; Bronchodilator Agents; Cross-Over Studies; Female; Horse Diseases; Horses; Levalbuterol; Lung Diseases, Obstructive; Male
PubMed: 27282625
DOI: 10.1111/jvim.14320