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Levalbuterol Versus Racemic Albuterol in the Treatment of Acute Exacerbation of Asthma in Children

Objective: To compare levalbuterol and racemic albuterol for the treatment of acute exacerbation of asthma in pediatric population. Design: Prospective, double-blind, randomized research trial in a pediatric emergency department of an urban tertiary care hospital. Participants: Children 5 to 21 years with a history of asthma presenting to the emergency department in acute exacerbation. Interventions: As per a computer-generated randomization sequence, patients received either 1.25 mg of levalbuterol or albuterol 2.5 mg via nebulization along with ipratropium hydrochloride. Patients received 3 back-to-back treatments as needed every 20 minutes, maximum of 3; 2 mg/kg of oral prednisone was administered to the patients after the second treatment. Baseline respiratory parameters such as oxygen saturations, respiratory rates, and peak flow rates were measured and repeated after every treatment. The decision for further treatments and or hospitalization was made by the treating emergency department physician as per his/her clinical judgement of the respiratory parameters at the end of 3 treatments. Results: Seventy patients completed the study. Most of the patients were in moderate severity of asthma exacerbation. All patients in both groups showed improvement in oxygen saturations, respiratory rates, and peak flow rates. However, no statistically significant difference was observed in the 2 groups regarding the respiratory parameters (P > 0.05). Conclusion: Levalbuterol is not more efficacious than racemic albuterol in improving respiratory parameters in children presenting with acute exacerbation of asthma.