Levalbuterol versus albuterol for acute asthma: A systematic review and meta-analysis

BackgroundConventional albuterol is a racemic mixture of (S)-albuterol and (R)-albuterol (levalbuterol). Levalbuterol is therapeutically active component of albuterol whereas (S)-albuterol is considered inert with some unwanted effects.ObjectivesTo evaluate efficacy and safety of levalbuterol versus albuterol in acute asthma.DesignSystematic review and meta-analysis.Data sourcesPubmed and Cochrane databases.Trial eligibility criteria, participants, and interventionsRandomized control trials comparing levalbuterol versus albuterol for acute asthma in all age groups.Data extraction and result synthesisTwo authors extracted data independently. Meta-analyses were performed using Review Manager Software.ResultsSeven trials including a total of 1625 participants fulfilled the eligibility criteria. Respiratory rate, oxygen saturation, and percentage change in FEV1 and clinical asthma score were not significantly different between the groups with mean difference (95% CI) of 0.35 (−0.81, 1.51), −0.29 (−0.68, 0.10), −28.3 (−59.95, 3.33) and −1.01 (−5.30, 3.28) respectively. There were no significant differences in side effects between groups.LimitationsData were not available for two probable eligible trials. A few assumptions and some calculated values were used for meta-analysis.ConclusionsLevalbuterol was not superior to albuterol regarding efficacy and safety in subjects with acute asthma. We suggest that levalbuterol should not be used over albuterol for acute asthma.