Comparison of racemic albuterol and levalbuterol in the treatment of acute asthma in the ED

Am J Emerg Med. 2005 Nov;23(7):842-7. doi: 10.1016/j.ajem.2005.04.003.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Albuterol / chemistry
  • Albuterol / economics
  • Albuterol / therapeutic use*
  • Asthma / drug therapy*
  • Asthma / economics
  • Bronchodilator Agents / chemistry
  • Bronchodilator Agents / economics
  • Bronchodilator Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • Emergency Service, Hospital / economics*
  • Female
  • Health Care Costs*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stereoisomerism
  • Treatment Outcome


  • Bronchodilator Agents
  • Albuterol