Albuterol enantiomer levels, lung function and QTc interval in patients with acute severe asthma and COPD in the emergency departmentReport as inadecuate




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International Journal of Emergency Medicine

, 4:30

First Online: 15 June 2011Received: 29 November 2010Accepted: 15 June 2011

Abstract

BackgroundThis observational study was designed to investigate plasma levels of albuterol enantiomers among patients with acute severe asthma or COPD presenting to the emergency department, and the relationship with extra-pulmonary cardiac effects QTc interval and lung function. Recent reviews have raised concerns about the safety of using large doses of β2-agonists, especially in patients with underlying cardiovascular comorbidity. It has been demonstrated that significant extrapulmonary effects can be observed in subjects given nebulised R-S-albuterol at a dose of as little as 6.5 mg.

MethodsBlood samples were collected and plasma-serum levels of R- and S-albuterol enantiomers were determined by LC-MS and LC-MS-MS assay. Extra-pulmonary effects measured at presentation included ECG measurements, serum potassium level and blood sugar level, which were collected from the hospital medical records.

ResultsHigh plasma levels of both enantiomers were observed in some individuals, with median range concentrations of 8.2 0.6-24.8 and 20.6 0.5-57.3 ng-mL for R- and S- albuterol respectively among acute asthma subjects, and 2.1 0.0-16.7 to 4.1 0.0-36.1 ng-mL for R- and S- albuterol respectively among COPD subjects. Levels were not associated with an improvement in lung function or adverse cardiac effects prolonged QTc interval.

ConclusionsHigh plasma concentrations of albuterol were observed in both asthma and COPD patients presenting to the emergency department. Extra-pulmonary cardiac adverse effects prolonged QTC interval were not associated with the plasma level of R- or S-albuterol when administered by inhaler in the emergency department setting. Long-term effects of continuous high circulating albuterol enantiomer concentrations remain unknown, and further investigations are required.

Electronic supplementary materialThe online version of this article doi:10.1186-1865-1380-4-30 contains supplementary material, which is available to authorized users.

Kwang Choon Yee, Glenn A Jacobson contributed equally to this work.

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Author: Kwang Choon Yee - Glenn A Jacobson - Richard Wood-Baker - E Haydn Walters

Source: https://link.springer.com/article/10.1186/1865-1380-4-30







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