Comparison of the dose response to levalbuterol with and without pretreatment with S-albuterol after methacholine-induced bronchoconstriction

Study Objective. To determine the effect of S-albuterol on the dose response to levalbuterol in patients with moderate bronchoconstriction induced by a methacholine challenge. Design. Prospective, randomized, double-blind, placebo-controlled, crossover study. Setting. University-affiliated clinical trial center. Patients. Twenty-two adults with mild, stable asthma. Intervention. At the screening visit, patients were switched from their beta(2)-agonist to ipratropium bromide for use as an as-needed rescue therapy At the baseline visit 2-6 days later, the provocative concentration of methacholine to induce a 30% decrease in forced expiratory volume in I second (FEV1 PC30) was determined, followed by a nebulized racemic albuterol dose-response study with three doses of albuterol, to familiarize patients with the procedures. At visits 2 and 3, patients were randomly assigned to receive nebulized normal saline placebo or S-albuterol 5 mg before the methacholine challenge and were administered three escalating doses of levalbuterol after the challenge. Measurements and Main Results. Area under the curve for FEV1 over 40 minutes (AUC(0-40)) after administration of levalbuterol was the primary outcome, with slope of FEV1 as the secondary outcome. In addition, the fraction of exhaled nitric oxide (FeNO) was measured before and after the challenges. In the 17 patients who met criteria for completion, no deleterious effect for S-albuterol was found for FEV1 PC30, AUC(0-40) FEV1, or the FEV, Slope(0-40). However, S-albuterol reduced the provocative concentration of methacholine to induce a 20% decrease in FEV1 (PC20 0.52 +/- 2.06 vs 0.39 +/- 1.58 mg/ml, placebo vs S-albuterol, p=0.044) but did not affect FeNO. Conclusion. A single high dose of S-albuterol did not alter the bronchodilator response to levalbuterol. The effect on bronchial responsiveness requires further study.