Comparison of racemic albuterol and levalbuterol for treatment of acute asthma

J Pediatr. 2003 Dec;143(6):731-6. doi: 10.1067/S0022-3476(03)00493-1.


Objective: To determine whether levalbuterol resulted in fewer hospital admissions than racemic albuterol when used for treatment of acute asthma. Study design A randomized, double-blind, controlled trial was conducted in the emergency department (ED) and inpatient asthma care unit of an urban tertiary children's hospital. Children age 1 to 18 years (n=482) provided a total of 547 enrollments. Patients received a nebulized solution of either 2.5 mg racemic albuterol or 1.25 mg levalbuterol every 20 minutes (maximum six doses). Patients admitted to the asthma care unit were treated in a standardized fashion by using the same blinded drug assigned in the ED. Hospitalization rate was the primary outcome.

Results: Hospitalization rate was significantly lower in the levalbuterol group (36%) than in the racemic albuterol group (45 %, P=.02). The adjusted relative risk of admission in the racemic group compared with the levalbuterol group was 1.25 (95% confidence interval, 1.01-1.57). Hospital length of stay was not significantly shorter in the levalbuterol group (levalbuterol, 44.9 hours; racemic albuterol, 50.3 hours; P=.63). No significant adverse events occurred in either group.

Conclusions: Substituting levalbuterol for racemic albuterol in the ED management of acute asthma significantly reduced the number of hospitalizations.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adolescent
  • Albuterol / chemistry*
  • Albuterol / therapeutic use*
  • Asthma / drug therapy*
  • Bronchodilator Agents / chemistry*
  • Bronchodilator Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Double-Blind Method
  • Emergency Service, Hospital
  • Female
  • Hospitalization*
  • Humans
  • Infant
  • Isomerism
  • Male


  • Bronchodilator Agents
  • Albuterol