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Friday’s COPD Newsletter from COPD Support, Inc.

Posted Nov 12 2010 2:16pm

Volume 10, Issue 49
November 12, 2010
Richard D. Martin, Editor

In response to last week’s article on atrial fibrillation, subscriber Jim A. shares some important information, which, in part reads:

~~Atrial fibrillation is frequently a consequence of the routine use of albuterol (salbutamol). Many of us have benefitted from switching to levalbuterol, which is just as effective in providing relief but is, unfortunately, cost prohibitive for many people. Formal studies on this are not conclusive, but research shows that at least for some, switching to levalbuterol (e.g., Xoponex) is beneficial in this respect.~~

Jim’s suggestion compels us to look at albuterol and levalbuterol and how they work. Albuterol is called salbutamol outside the U.S.. Similarly, what is known as levabuterol in the U.S. is called levosalbutamol outside of the U.S. They are both bronchodilators, and are closely related. Levalbuterol is more expensive than albuterol, because it is harder to manufacture. In the following discussion, the two medications will simply be referred to as “albuterol” and “levalbuterol.” Albuterol is available under many brand names such as Accuneb, ProAir, Proventil, Ventolin, Vospire, Asthelin, etc. In some cases there are variations in the spelling of the brand names (e.g., Ventolin/Ventorlin) depending on the country of origin. There is only one brand name of levalbuterol available in the U.S.: Xopenex. There is no generic levalbuterol available in the U.S. The brand name Levolin (levalbuterol) is available in some countries, but not the U.S. The above terminology is from Wikipedia at

The preference of one medication over the other (or neither medication) is a decision only you and your doctor should make. Nevertheless, it might be beneficial to know something about each of these two related medications to help you in your discussion with your doctor.

How Albuterol and Levalbuterol are Related

The difference between albuterol and levalbuterol starts at a chemical level. To simplify (or oversimplify) the differences, it is important to know that albuterol consists of equal amounts of two types of albuterol molecules. Let’s call them right-handed and left-handed albuterol molecules. If the idea of right and left-handed molecules throws you, just think of them as being being red (for right-handed) and lime green (for left-handed). The right-handed albuterol molecules are the ones that provide the bronchodilation we desire. The left-handed molecules provide little if any help and according to some experts, can become a problem. Those experts believe left-handed molecules cause many of the side effects we find undesirable, such as increased heart rate and shakiness. Secondarily, the left-handed molecules take much longer to leave our body and can result in them building up to a harmful level if we use too much albuterol. This harmful buildup, some claim, can result in the opposite effect than the medication is intended to produce: instead of acting as a bronchodilator, it can cause bronchospasms (called paradoxical bronchospasms). For more information, and a more technical explanation of the chemistry of these two medications, see Wikipedia’s entries under “albuterol” and “levalbuterol” at

Levalbuterol is only the right-handed molecules of albuterol. The alleged troublesome left-handed molecules are removed, and along with it, theoretically, the negative side effects and problem of them building up in our bodies. The drug manufacturer Sunovision (formerly Sepracor until October 12, 2010) holds the only U.S. patent for this medication. It is called Xopenex. Cipla (The Chemical, Industrial, Pharmaceutical Laboratories, Ltd., located in India) also manufactures levalbuterol under the brand name Levolin. Separating the right from the left-handed molecules is a costly process, and it is reflected in a higer retail price for Levalbuterol. This significant cost difference may limit the availability of levabuterol in some drug plans. You can find more information on levalbuterol on the National Institutes of Health’s website at

Here is just one of the many sites that explains most of what you need to know about albuterol

Jim A. was definitely correct when he said studies that point out the benefits of levalbuterol over albuterol are inconclusive. Unfortunately, some of the best websites that compare the two medications require a subscription. As an example of the range of findings, Chest, the journal of the American College of Chest Physicians, concludes in one 2003 study, that hospitalized patients receiving levalbuterol have shorter hospital stays, need less medication, and have more prolonged therapeutic benefit from the medication. However, this study is not without its critics. It can be found at

In contrast, a 2008 study at George Washington University, Washington DC, concludes there is no difference in rapid heart rate between albuterol and levalbuterol. Incidentally, rapid heart rate is one of the most commonly cited reasons for switching from albuterol to levalbuterol. The study, however, was conducted on asthmatics without heart problems.

It would be reassuring to know if there are any definate benefits of using levalbuterol over albuterol, but as Jim points out, studies, as a whole, are inconclusive. In addition, different studies use differnt subjects, such as children or asthmatics. This adds to the confusion. People with heart problems might need special consideration. It is also important to point out that there are two very different issues raised concerning albuterol. Some of us may be concerned with one of the potential problems but not the other. They are: (1) dealing with the undesirable side effects such as shakiness and increased heart rate, and (2) the consequence of possible bronchospasms in individuals who use too much albuterol. If you have cardiac problems, find the side effects troubling, or fear you are concerned that you are using too much albuterol, it might be time to engage you doctor in a hearty conversation. Their experience with other patients may provide valuable information not always captured in scientific studies.


SOURCES: News items summarized in The COPD-NEWS are taken from secondary sources believed to be reliable. However, the COPD Family of Services does not verify their accuracy.

Pfizer Canada has introduced a full treatment of antibiotics in a single dose. PrZmax SR is a sustained release version of the antibiotic azithromycin. The antibiotic is intended for the treatment of mild community acquired pneumonia, acute bacterial exacerbations of chronic bronchitis, and acute bacterial sinusitis. The news release can be viewed at

An article in Chest, the journal of the American College of Chest Physicians, reports that a poor diet may worsen lung function in people with COPD. Researchers claim that diets low in certain antioxidants like A, C, D, E, and selenium may lead to decreased lung function. Men were more susceptible than women. Further, they found that a diet low in antioxidants was common in people with COPD. The researchers state: “strategies for dietary modification and supplementation should be considered in patients with COPD.” You’ll find the article at

Novartis, the manufacturer of Onbrez (indacaterol) is claiming that its once-daily medication is better than Spiriva (made by Boehringer Ingelheim/Pfizer). Specifically, they assert it is equal to Spiriva in improving lung function, but superior when it comes to decreasing breathlessness, lowing the use of rescue medications, and improving health. Although approved in the European Union, it is pending approval in the United States. For more information, see the PharmaTimes online report at

We do not accept any paid advertising. Any corporations, products, medicines (prescription or over the counter) mentioned in this newsletter are for informational purposes only and not to be construed as an endorsement or condemnation of same.

The British Journal of Sports Medicine reports exercising 5 times a week will reduce the number and symptoms of colds. They also stress the overall level of fitness as a key factor in preventing colds and reducing their symptoms. They attribute the benefits of exercise to a temporary increase in the immune system. The abstract of this study is available at
For a good discussion of the study, this Medical News Today article fits the bill

If you are not impressed with the benefits of regular exercise in reducing colds, perhaps you’ll be impressed with the findings of this study published in the British Journal of Psychiatry concerning the benefits of physical activity. The study demonstrates that those who engage in regular physical activity, even if the activity is less than intensive, have fewer symptoms of depression. Further, the more leisure time activities one is engaged in, the better the results. Social support and involvement seems to be an important factor in reaping the benefits of leisure activities. They also found that activity related to work, even if rigorous, does not provide the same beneficial result. The study, in the British Journal of Psychiatry can be found at

Don’t feel guilty about those afternoon naps! Studies find they help “older people” restore their energy, enabling them (us) to lead more active lives. Need more convincing? Then read this Medical News Today article at

MEDICAL DECISIONS. Your physician should be consulted on all medical decisions. New procedures or drugs should not be started or stopped without such consultation. While we believe that our accumulated experience has value, and a unique perspective, you must accept it for what it is… the work of COPD patients . We vigorously encourage individuals with COPD to take an active part in the management of their disease. They do this through education and by sharing information and thoughts with their primary physician and pulmonologist. However, medical decisions are based on complex medical principles and should be left to the medical practitioner who has been trained to diagnose and advise.

Hospitalized patients being treated for non life-threatening COPD exacerbations miss nearly a quarter of their scheduled nebulized treatments, according to this recent study in Chest, the journal of the American College of Chest Physicians. The researchers recommend addressing this failure by replacing nebulized treatments with metered dose inhaler treatments. Of special interest to us is that this study focuses on the patient and claims they “missed” their treatment rather than focus on the failure of medical staff to properly administer prescribed medical treatment. For the abstract, see

Medicare’s new pilot program requires vendors to competitively bid for Medicare contracts. The contracts include supplying home and portable oxygen. Apria and Lincare are among the 356 companies awarded contracts that will start on January 1, 2011. The pilot program covers the metropolitan areas of Charlotte, North Carolina; Cincinnati; Cleveland; Dallas; Kansas City; Miami; Orlando, Florida; Pittsburgh; and Riverside, California. A bill to repeal this competitive bidding program is attracting sponsors. This Bloomberg article explains it in more detail
If you live in one of the above areas, you can get a list of the “winners” in your area at

The American Physical Therapy Association (APTA) reports that Medicare is cutting payments for outpatient physical therapy by 7 to 9 percent starting in January 1, 2011. They also report that in addition to these cuts, there is a new $1,870 cap on outpatient physical therapy (not to be confused with pulmonary rehabilitation). The AAPT report can be read at

JOIN US? Subscription to this Newsletter is free and we hope that it serves your needs. For more Newsletter information, go to:

The Newsletter, like all the other endeavors of the Family of COPD Support Programs , is provided to you by COPD-Support, Inc . a non-profit member organization with IRS designation 501(c)(3). If you would like to be involved and help us provide these programs to the individuals who benefit from them, please consider joining us as a member. Further information is available at:

Sometimes the simple ones are the best, but be prepared for the annoying sound that greets you when you enter the website!

Come on, do something wild and enter National Geographic’s photography contest! No, you don’t have to travel to exotic places to take an award-winning picture, and that can be proven by viewing winning photographs. If you are not inclined to grab your camera, you can still enjoy the work of others by browsing through National Geographic’s photo galleries. You won’t be disappointed.

Who among us doesn’t appreciate television programs from the past (although we could really do without the “oldies” reference)? You’ll find many of televisions finest moments at

To view Veterans Day posters from 1978 to the present, see

Before you buy something online from a major retailer, it is worth looking to see if there is a coupon code available that will help you save money. You enter coupon codes when you “check out.” Sometimes it is a simple percentage discount, sometime free shipping, and sometimes even a free gift. If you search for “discount codes” you will find many sites that provide these codes. It is worth visiting a few different sites. Codes from trustworthy sites are available without registering. You can usually see if the code works properly before you click the final button to complete your purchase. Below is just one of the many websites you’ll find discount codes

For comments and questions, or to contact Richard D. Martin, please send your email to:

Until next Friday,

Richard D. Martin, Editor

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