Levalbuterol versus albuterol for acute asthma: a systematic review and meta-analysis

Pulm Pharmacol Ther. 2013 Apr;26(2):239-48. doi: 10.1016/j.pupt.2012.11.003. Epub 2012 Nov 30.


Background: Conventional albuterol is a racemic mixture of (S)-albuterol and (R)-albuterol (levalbuterol). Levalbuterol is therapeutically active component of albuterol whereas (S)-albuterol is considered inert with some unwanted effects.

Objectives: To evaluate efficacy and safety of levalbuterol versus albuterol in acute asthma.

Design: Systematic review and meta-analysis.

Data sources: Pubmed and Cochrane databases. TRIAL ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: Randomized control trials comparing levalbuterol versus albuterol for acute asthma in all age groups. DATA EXTRACTION AND RESULT SYNTHESIS: Two authors extracted data independently. Meta-analyses were performed using Review Manager Software.

Results: Seven trials including a total of 1625 participants fulfilled the eligibility criteria. Respiratory rate, oxygen saturation, and percentage change in FEV1 and clinical asthma score were not significantly different between the groups with mean difference (95% CI) of 0.35 (-0.81, 1.51), -0.29 (-0.68, 0.10), -28.3 (-59.95, 3.33) and -1.01 (-5.30, 3.28) respectively. There were no significant differences in side effects between groups.

Limitations: Data were not available for two probable eligible trials. A few assumptions and some calculated values were used for meta-analysis.

Conclusions: Levalbuterol was not superior to albuterol regarding efficacy and safety in subjects with acute asthma. We suggest that levalbuterol should not be used over albuterol for acute asthma.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Acute Disease
  • Albuterol / therapeutic use*
  • Asthma / drug therapy*
  • Asthma / physiopathology
  • Bronchodilator Agents / therapeutic use*
  • Forced Expiratory Volume / drug effects
  • Humans
  • Stereoisomerism


  • Bronchodilator Agents
  • Albuterol