Cardiac effects of levalbuterol vs. albuterol in pediatric asthma attack patients: A systematic review and meta-analysis

IF 0.6 Q4 PEDIATRICS

PROGRESS IN PEDIATRIC CARDIOLOGY Pub Date : 2024-04-22 DOI:10.1016/j.ppedcard.2024.101725

Baraa Shebli , Moamen Mostafa Asla , Mike Ghabally , Muhammad Besher Shabouk , Rand Batal , Mahmoud Malhis

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引用次数: 0

Abstract

Background

Beta-2 agonists are the standard of care for asthmatic patients. Racemic albuterol and levalbuterol are two of the most commonly used bronchodilators in this category. Although their efficacy has been tested excessively, their effects on heart rate remain debatable in the medical literature.

Aim of review

This review aims to summarize all available data in the literature concerning the effects of Racemic Albuterol versus Levalbuterol on heart rate in asthmatic children.

Key scientific concepts of review

Our search covered five different databases: PubMed, SCOPUS, Wiley Online Library, Web of Science, and Cochrane Library. We included clinical trials investigating heart rate in asthmatic pediatric patients, either as a primary or secondary outcome. The primary outcome was heart rate changes. Secondary outcomes were respiratory rate, FEV1 peak percent changes, potassium serum levels, SpO2 peak changes, asthma score, and adverse effects. Eight clinical trials were included; seven of them were eligible for meta-analysis. In a dosing ratio of levalbuterol: albuterol =1:4, levalbuterol showed better outcomes on heart rate changes when compared with racemic albuterol (mean difference = −5.97, p = 0.02). However, this difference was dose-dependent as it vanished with equivalent dosing of levalbuterol: albuterol = 1:2. Levalbuterol also had a better effect on FEV1 changes (mean difference = 3.72, p = 0.003). However, there was no statistically significant difference between the two drugs regarding changes in respiratory rate, SpO2, asthma score, or adverse effects. In conclusion, levalbuterol and racemic albuterol have almost the same effect on heart rate in asthmatic children when they are used in equivalent dosing.

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勒曲特罗与阿布特罗对小儿哮喘发作患者心脏的影响：系统回顾和荟萃分析

背景β-2激动剂是哮喘患者的标准治疗药物。消旋盐酸阿布特罗和利伐布特罗是这类药物中最常用的两种支气管扩张剂。本综述旨在总结有关消旋盐酸阿布特罗和利乌布特罗对哮喘儿童心率影响的所有现有文献数据：我们的检索涵盖五个不同的数据库：PubMed、SCOPUS、Wiley Online Library、Web of Science 和 Cochrane Library。我们纳入了研究哮喘儿科患者心率的临床试验，无论是作为主要结果还是次要结果。主要结果是心率变化。次要结果包括呼吸频率、FEV1 峰值百分比变化、血钾血清水平、SpO2 峰值变化、哮喘评分和不良反应。共纳入八项临床试验，其中七项符合荟萃分析条件。与外消旋盐酸阿布特罗相比，在瘦肉精：阿布特罗=1:4的剂量比例下，瘦肉精对心率变化的疗效更好（平均差异=-5.97，P=0.02）。然而，这种差异与剂量有关，因为在瘦肉精：阿布特罗=1:2的同等剂量下，这种差异消失了。勒曲特罗对 FEV1 变化也有更好的效果（平均差异 = 3.72，p = 0.003）。然而，在呼吸频率、SpO2、哮喘评分或不良反应的变化方面，两种药物之间没有统计学意义上的显著差异。总之，在使用相同剂量时，勒曲特罗和外消旋阿布特罗对哮喘儿童心率的影响几乎相同。

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来源期刊

PROGRESS IN PEDIATRIC CARDIOLOGY PEDIATRICS-

CiteScore

0.90

自引率

11.10%

发文量

审稿时长

75 days

期刊介绍： Progress in Pediatric Cardiology is an international journal of review presenting information and experienced opinion of importance in the understanding and management of cardiovascular diseases in children. Each issue is prepared by one or more Guest Editors and reviews a single subject, allowing for comprehensive presentations of complex, multifaceted or rapidly changing topics of clinical and investigative interest.