Internal Medicine News - Levalbuterol does not top albuterol in treating COPD
SAN DIEGO — Levalbuterol was no more effective than albuterol in chronic obstructive pulmonary disease in a single-dose comparison trial.
Nor was the combination of ipratropium and albuterol more effective at increasing forced expiratory volume in 1 second ([FEV.sub.1]) than albuterol alone. The bronchodilator effect of the combination did last somewhat longer, but not beyond 3-4 hours, Dr. Debapriya Datta said at the annual meeting of the American College of Chest Physicians.
He studied 30 chronic obstructive pulmonary disease patients with an [FEV.sub.1] less than 70% of predicted; on each of four occasions, they used albuterol (2.3 mg), 1evalbuterol (1.25 mg), ipratropium and albuterol (0.5 mg and 2.3 mg), or placebo. He then took serial measurements of [FEV.sub.1].
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Prior to the study all patients were using a short-acting 3-agonist, and most were using a long-acting 3-agonist, said Dr. Datta of the department of pulmonary and critical care medicine, St. Francis Hospital and Medical Center, Hartford, Conn.
At 0.5 hour after use, the mean improvement in [FEV.sub.1] was 0.2 L with albuterol, 0.18 L with levalbuterol, 0.2 L with the combination, and 0.07 L with placebo. The mean baseline [FEV.sub.1] for the patients was 1.15 L.
At 3 hours, only the combination was still producing a statistically significantly improvement, compared with placebo. The mean improvement in [FEV.sub.1] was 0.12 L with albuterol, 0.11 L with levalbuterol, 0.18 L with the combination, and 0.05 L with placebo.
By 4 hours none of the drugs had an effect that was significantly different from that of placebo. In fact, the rapid drop-off in effect may indicate that chronic obstructive pulmonary disease patients experience some tachyphylaxis from regular [beta]-agonist use, Dr. Datta said.
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