Abstract
Background. Exercise-induced bronchospasm (EIB) affects up to 90% of all patients with asthma. Objective. This study evaluated the ability of levalbuterol hydrofluoroalkane (HFA) 90 μg (two actuations of 45 μg) administered via metered dose inhaler (MDI) to protect against EIB in mild-to-moderate asthmatics. Methods. This was a randomized, double-blind, placebo-controlled, two-way cross-over study. Patients with asthma (n = 15) were ≥18 years, had a ≥6-month history of EIB, ≥ 70% baseline predicted forced expiratory volume in 1 second (FEV1), and a 20% to 50% decrease in FEV1 after treadmill exercise challenge using single-blind placebo MDI. Levalbuterol or placebo was self-administered 30 minutes before exercise. Treatment sequences were separated by a 3-to 7-day washout period. Spirometry was performed predose, 20 minutes postdose/pre-exercise, and 5, 10, 15, 30, and 60 minutes post-exercise. The primary endpoint was the maximum percent decrease in FEV1 from baseline (postdose/pre-exercise). The percentage of protected (≤ 20% decrease in post-exercise FEV1) patients was also assessed. Results. Levalbuterol had significantly smaller maximum percent post-exercise decrease in FEV1 compared with placebo (LS mean ± SE; −4.8% ± 2.8% versus −22.5% ± 2.8%, respectively). For levalbuterol, 14/15 (93.3%) patients had < 20% decrease in post-exercise FEV1 compared with 8/15 (53.3%) for placebo (p = 0.0143). Treatment was well tolerated. Conclusion. Levalbuterol HFA MDI (90 μg) administered 30 minutes before exercise was significantly more effective than placebo in protecting against EIB after a single exercise challenge and was well tolerated. Clinical Implications. Levalbuterol HFA MDI when administered before exercise was effective in protecting adults with asthma from EIB.
Highlights
Exercise-induced bronchospasm (EIB) is a common condition occurring in up to 90% of patients with asthma and in up to 10% of patients that are not known to be asthmatic [1, 2]
The maximum percent decrease in forced expiratory volume in 1 second (FEV1) from visit postdose/pre-challenge was significantly less in patients treated with levalbuterol compared with placebo (LS mean ± SE: −4.8% ± 2.8% and −22.5% ± 2.8%, respectively; p = 0.0002) (Figure 1A)
We examined the ability of levalbuterol HFA 90 μg administered through an metered dose inhaler (MDI) to protect adults with asthma from EIB
Summary
Exercise-induced bronchospasm (EIB) is a common condition occurring in up to 90% of patients with asthma and in up to 10% of patients that are not known to be asthmatic [1, 2]. Patients with asthma (n = 15) were ≥18 years, had a ≥6-month history of EIB, ≥70% baseline predicted forced expiratory volume in 1 second (FEV1), and a 20% to 50% decrease in FEV1 after treadmill exercise challenge using single-blind placebo MDI. Levalbuterol had significantly smaller maximum percent post-exercise decrease in FEV1 compared with placebo (LS mean ± SE; −4.8% ± 2.8% versus −22.5% ± 2.8%, respectively). 14/15 (93.3%) patients had
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