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

Citation

Yee, KC and Jacobson, GA and Wood-Baker, R and Walters, EH, Albuterol enantiomer levels, lung function and QTc interval in patients with acute severe asthma and COPD in the emergency department, International Journal of Emergency Medicine (Online) , 4, (1) Article 30. ISSN 1865-1380 (2011) [Refereed Article]


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Copyright Statement

© 2011 Yee et al; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

DOI: doi:10.1186/1865-1380-4-30

Abstract

Background: This 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.

Methods: Blood 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.

Results: High 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).

Conclusions: High 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 effect(s) of continuous high circulating albuterol enantiomer concentrations remain unknown, and further investigations are required.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Respiratory Diseases
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Respiratory System and Diseases (incl. Asthma)
Author:Yee, KC (Dr Kwang Yee)
Author:Jacobson, GA (Dr Glenn Jacobson)
Author:Wood-Baker, R (Professor Richard Wood-Baker)
Author:Walters, EH (Professor Haydn Walters)
ID Code:72578
Year Published:2011
Deposited By:Menzies Institute for Medical Research
Deposited On:2011-08-29
Last Modified:2014-12-13
Downloads:213 View Download Statistics

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