Randomized placebo controlled assessment of airway inflammation due to racemic albuterol and levalbuterol via exhaled nitric oxide testing

John F Freiler¹, Rajiv Arora², Thomas C Kelley³, Larry Hagan³, Patrick F Allan³
 

¹Dept of Allergy/Immunology, 101 Bodin Circle, Travis AFB, CA, USA; ²Walter Reed Army Medical Center, Department of Allergy and Immunology, Washington DC, USA; ³Department of Pulmonary/Critical Care, Lackland AFB, TX, USA

Study Objectives: The S-stereoisomer found in racemic albuterol may have associated proinflammatory properties. We tested the hypothesis that airway inflammation as assessed by exhaled nitric oxide is no different in patients with COPD when using racemic albuterol relative to levalbuterol or placebo.

Measurements: Twelve mild to moderate COPD patients were assigned to five days each of nebulized racemic albuterol, levalbuterol, and saline placebo. Before and after each course of treatment, airway inflammation was assessed via exhaled nitric oxide breath testing. Secondary functional outcomes that were measured included spirometry, a functional assessment utilizing a six-minute walk, and symptoms score using the University of California, San Diego Shortness of Breath Questionnaire.

Results: There was no statistically significant difference in pre and post FeNO levels within and between treatment groups (p = 0.121). There were also no significant differences within or between treatment groups for the secondary outcome measurements of FEV₁ (p = 0.913), functional assessment utilizing a six-minute walk (p = 0.838) and the symptom scores using Shortness of Breath Questionnaire (p = 0.500).

Conclusion: We found no difference in mild to moderate COPD patients treated with racemic albuterol, levalbuterol or placebo for measurement of exhaled nitric oxide or the secondary outcomes that were measured.

Keywords: Airway inflammation, albuterol, COPD, exhaled nitric oxide, levalbuterol