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Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
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Clinical experience with levalbuterol.

H S Nelson1

  • 1Department of Medicine, National Jewish Medical and Research Center, Denver, CO 80206, USA.

The Journal of Allergy and Clinical Immunology
|August 19, 1999
PubMed
Summary
This summary is machine-generated.

Pure (R)-albuterol (levalbuterol) offers superior bronchodilation compared to racemic albuterol. The (S)-albuterol component in racemic mixtures may negatively impact airway function.

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Area of Science:

  • Pharmacology
  • Respiratory Medicine
  • Drug Efficacy

Background:

  • Racemic albuterol, while a bronchodilator, can lead to reduced potency and increased airway hyperresponsiveness with regular use.
  • Experimental data suggests that (S)-albuterol, a component of racemic albuterol, may induce bronchial hyperresponsiveness.
  • These observations raise questions about the comparative efficacy of pure (R)-albuterol (levalbuterol) versus racemic albuterol.

Purpose of the Study:

  • To compare the bronchodilator efficacy and effects on airway responsiveness of pure (R)-albuterol (levalbuterol) against racemic albuterol.
  • To investigate the potential negative impact of the (S)-albuterol enantiomer present in racemic mixtures.

Main Methods:

  • Clinical studies involving single and multiple doses in adults and children.
  • Assessment of bronchodilation and protection against bronchoprovocation (e.g., methacholine challenge).
  • Evaluation of baseline airway caliber (FEV1) over a 4-week treatment period.

Main Results:

  • Single doses of levalbuterol demonstrated more prolonged protection against methacholine challenge than racemic albuterol.
  • (S)-albuterol administration significantly increased sensitivity to methacholine.
  • In a 4-week study, pure levalbuterol provided greater bronchodilation than racemic mixtures, and baseline FEV1 was lower with the racemate compared to levalbuterol or placebo.
  • Studies in children confirmed greater bronchodilation with pure levalbuterol.

Conclusions:

  • Pure (R)-albuterol (levalbuterol) is more effective as a bronchodilator than equivalent amounts in a racemic mixture.
  • The (S)-albuterol enantiomer appears to have a deleterious effect on acute bronchodilator response and baseline airway caliber.
  • Further research is needed to elucidate the precise mechanisms behind the adverse effects of (S)-albuterol.