Albuterol administration is commonly associated with increases in serum lactate in asthmatics treated for acute exacerbation of asthma. (Fortenberry)

Lewis LM, Ferguson I, House SL, Aubuchon K, Schneider J, Johnson K, Matsuda K. Albuterol administration is commonly associated with increases in serum lactate in asthmatics treated for acute exacerbation of asthma. Chest. 2014 Jan; 145(1): 53–59.

BACKGROUND: Controversy exists surrounding the incidence and cause of hyperlactatemia during asthma exacerbations. We evaluate incidence, potential causes, and adverse events of hyperlactatemia in patients with acute asthma exacerbation.

METHODS: Sub-analysis of placebo subjects from a prospective, randomized trial evaluating an intravenous beta-adrenergic agonist in acute asthma exacerbation (clinicaltrials.gov identifier NCT00683449).Subjects had plasma albuterol, serum lactate and bicarbonate concentrations measured at baseline and 1.25 hours as well as dyspnea score and spirometry measured at baseline and hourly for 3 hours. All subjects had a therapeutic trial consisting of 5-15 mg of nebulized albuterol, 0.5-1 mg of nebulized ipratropium, and at least 50 mg of oral prednisone, or its equivalent prior to initiation of the study. Following randomization, subjects were treated with continued albuterol and intravenous magnesium at the discretion of their treating physician. Subjects were followed to admission or discharge with follow up at 24 hours and 1 week.

Results: 175 subjects were enrolled in the parent trial, 84 in the placebo group. 65 had complete data. Mean albuterol administration prior to baseline was 12.3mg (SD±5.3).Mean baseline lactate was 18.5mg/dL (SD±8.4) vs. 26.5mg/dL (SD±11.8) at 1.25 hours; p>0.001. 45 subjects (69.2%) had hyperlactatemia. Mean baseline bicarbonate was 22.6mEq/L (SD±2.9) vs. 21.9mEq/L (SD±4.0) at 1.25 hours; p=0.11.Plasma albuterol concentration correlated to lactate concentration (β coefficient=0.45; p<0.001), and maintained significant association after adjusting for asthma severity (β=0.41; p=0.001). Hyperlactatemia did not increase the risk of hospitalization/relapse (p=0.26), nor was it associated with lower %FEV1 at 3 hours (p=0.54).

CONCLUSION: Plasma albuterol was significantly correlated with serum lactate concentration, after adjusting for asthma severity. Hyperlactatemia was not associated with poorer pulmonary function as measured by 3-hour %FEV1, or increased hospitalization/relapse at one week.

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