Levalbuterol Is No Better Than Racemic Albuterol for Severe Acute Asthma

Albuterol, the most commonly prescribed inhaled medication for acute asthma exacerbations, is a racemic mixture of two enantiomers. Levalbuterol, the (R)-albuterol enantiomer, is the therapeutically active molecule that binds to β₂-adrenergic receptors and causes bronchodilation, along with adverse effects such as tachycardia. In theory, the (S)-albuterol enantiomer has the potential to intensify airway inflammation and hyperresponsiveness. Clinical comparisons of levalbuterol and racemic albuterol in children with acute asthma have been equivocal.

To compare levalbuterol and racemic albuterol in children with severe acute asthma, investigators in a Philadelphia pediatric emergency department (ED) randomized 81 children (age range, 6–18 year…