As a pediatric hospitalist, I am seeing more and more children receiving levalbuterol nebulizer treatments. Some of their parents request levalbuterol in the hospital rather than albuterol. I am confused on the manufacturer’s claims. Does levalbuterol have a clinically superior safety profile? Are there fewer adverse effects? How does it compare in terms of efficacy? Finally, are there any data on continuous levalbuterol nebulization therapy for patients in severe status asthmaticus?

The precise role of levalbuterol in asthma therapy for children still is being defined. National guidelines recommend short-acting inhaled beta2-agonists for quick relief (“rescue”) from acute asthma symptoms. (1) The most common rescue medication for childhood asthma is racemic albuterol, usually referred to simply as “albuterol.” Levalbuterol is the R-isomer of albuterol. Organic compounds that have the same molecular formula are called isomers. Stereoisomers are isomers that differ in their orientation in space by their...

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