Clinical outcomes of levalbuterol versus racemic albuterol in pediatric patients with asthma: Propensity score matching approach in a medicaid population

Pediatr Pulmonol. 2017 Apr;52(4):516-523. doi: 10.1002/ppul.23565. Epub 2016 Oct 4.


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.

Keywords: Medicaid; albuterol; asthma; levalbuterol; pediatric.

MeSH terms

  • Adolescent
  • Albuterol / administration & dosage
  • Albuterol / therapeutic use*
  • Asthma / drug therapy*
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Hospitalization
  • Humans
  • Levalbuterol / administration & dosage
  • Levalbuterol / therapeutic use*
  • Male
  • Medicaid / statistics & numerical data
  • Propensity Score
  • Retrospective Studies
  • South Carolina
  • Treatment Outcome
  • United States


  • Bronchodilator Agents
  • Levalbuterol
  • Albuterol