Initially, mg inhaled by nebulization 3 times per day, given every 6 to 8 hours. Patients who do not respond adequately may benefit from a dosage of mg inhaled by nebulization 3 times per day. Levalbuterol may be used as needed for first line therapy for GOLD group A category patients with stable COPD (few symptoms and a low risk of exacerbation). Levalbuterol may be used routinely or with a short-acting anticholinergic in group A patients who continue to have evidence of bronchospasm with monotherapy, or a long-acting bronchodilator may be introduced; levalbuterol may also be used in GOLD B, C, and D category patients with stable disease for additional symptom control. For single-dose, as needed use, there appears to be no advantage in using levalbuterol over albuterol. Evidence does not support the use of high doses of levalbuterol on an as needed basis in patients already treated with long-acting bronchodilators. Short-acting beta-2 agonists such as levalbuterol are preferred therapy for the treatment of acute COPD exacerbations, used with or without a short-acting anticholinergic. Increasing the dosage and/or frequency of administration during an exacerbation is recommended for clinical improvement. The optimal dosage of levalbuterol for the treatment of a COPD exacerbation is not established; adjust dose according to clinical symptoms or the development of adverse effects. No significant differences in FEV-1 have been demonstrated between metered-dose inhalers (with or without a spacer) and nebulizers among short-acting bronchodilators in clinical trials; nebulizers may be more convenient for sicker patients.
A multicenter, randomised, double-blind, active-controlled, non-inferiority study was conducted to assess the immunogenicity of Fluenz Tetra compared to Fluenz (active control) in children and adolescents 2-17 years of age. A total of 2,312 children and adolescents were randomised by site at a 3:1:1 ratio to receive either Fluenz Tetra or one of two formulations of comparator vaccine Fluenz, each containing a B strain that corresponded to one of the two B strains in Fluenz Tetra (a B strain of the Yamagata lineage and a B strain of the Victoria lineage).
Use of QVAR with a spacer device in children less than 5 years of age is not recommended. In vitro dose characterization studies were performed with QVAR 40 mcg/actuation with the OptiChamber and AeroChamber Plus ® spacer utilizing inspiratory flows representative of children under 5 years old. These studies indicated that the amount of medication delivered through the spacing device decreased rapidly with increasing wait times of 5 to 10 seconds as shown in Table 2. If QVAR is used with a spacer device, it is important to inhale immediately.