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

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.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).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.Albuterol (salbutamol), a β2-agonist, plays an important role in emergency medicine and is the first line medication for relief of shortness of breath during acute asthma exacerbations. Albuterol is also used on a regular basis for the management of chronic obstructive pulmonary disease (COPD), both during stable periods and acute exacerbations [1-3]. Many recent studies and guidelines have indicated that the use of short-acting β2-agonists on a regular basis will not improve asthma control, and may even cause deterioration [4-6]. However, regular use of short-acting β2-agonists such as albuterol is still very common for the management of COPD [1-3].Albuterol is a chiral compound consisting of (R)- and (S)- enantiomers, and is most commonly administered as a 1:1 rac