Archived Q&A and Reviews


Albuterol vs. Xopenex

March 2006

Has anyone tried albuterol and xopenex to treat their child's asthma? Did your child experience different side effects? It is my understanding that the two medications do the same thing but the xopenex does not have the same side effects as albuterol (such as the 'racing heart' or the hyper behavior) and most people prefer xopenex. Just wondering. trying to find an alternative to albuterol. thanks anonymous

I would WHOLE HEARTEDLY recommend Xopenex. Our son was on Albuterol for 2 years for his asthma. His hands would tremble so badly that he couldn't hold his toys or feed himself. And, the shot of ''adrenaline'' felt by the albuterol would upset his stomach. He was so hyper that he couldn't fall asleep until 10 or 11pm. Our doctor recommended Xopenex about a year and a half ago. It is MAGICAL. My son has no side-effects from it at all.

And, it works just as well as albuterol for my son's asthma. Our doctor just described it as a purer form of albuterol. He said that they have figured out how to separate the two compounds in albuterol and discard the compound that causes the side-effects. The only draw back is that Xopenex is much more expensive. We paid a 5 dollar copay for albuterol and 35 for xopenex. For us, though, it was money well spent. Deep breathing

I am sorry you and your family are having to deal with asthma. I have an asthmatic 5 year old who has needed the meds you asked about during and after most of his childhood bugs. Only in the last few years have we added Xopenex to the Albuterol and Atrovent arsenal. We were told the same, that Xopenex might have fewer/decreased side effects. However, we've found it more expensive. Through a process of trial and error to figure out what works best, we have started a plan for alternating the two meds that was a bit counter-intuitive.

We're now using Xopenex during the day to save him the jitters and Albuterol at night when we are more confident that the side effects of Albuterol won't keep him up or prevent him from falling asleep. So, for example, if he needs a treatment 1 hr before bedtime, we'd give him Xopenex. If we know he's tired and about to sleep, we have him fall asleep with a nebulizer full of Albuterol. Overall, we've been very frustrated by the asthma meds: both the preventative (in my son's case, Flovent and Singulair) and those we use when he is symptomatic. We find that it is hard to tell how effective the meds are. Most of the time, they keep him out of the hospital but do not keep him (and us) from suffering for days each time he gets sick. Feel free to contact me with questions or commiserations. Marjorie

my daughter is on Xopenex. its generic name is levo-albuterol which leads me to believe it is very similar to albuterol on a molecular level. the molecule may be a mirror image of albuterol or have a small extra portion added or something like that. She is on Xopenex because Albuterol has no effect on her what-so- ever. I've been told that Xopenex has fewer side effects and is more targeted to affect asthma symptoms only. it tends to last longer so doses are less frequent. it is certainly more expensive and we get the nebulized version which means several minutes of a mask on my one-year-old's face and a nebulizer which arisolizes the medication so she can breathe it. It just became available in inhaler form in the last month or so. anon

Wheezing/Asthma/Albuterol Use in infant

Feb 2001

My five month old has had two episodes of wheezing, the first at about 2 months of age and the second at about four months, possibly in response to a mild RSV infection the first time (no fever or lethargy), and in response to a series of cold viruses the second time. I can hear the wheezing but don't notice other symptoms of breathing trouble. I know very little about wheezing or asthma and of course am trying to get as much information as possible from the pediatrician. (Also, I've read the Parent's network info. and have looked at Medline and am continuing this search--there are thousands of relevant references.) What I'd like to know is: (1) More about wheezing and asthma in general--Is wheezing a symptom or precursor to asthma? What are some good websites for learning about wheezing and asthma in infants and children; are there any good, recently published books on asthma in infants and children? (2) I also want to know a lot more about treatment, especially albuterol. I was told albuterol is not a steroid by the pediatrician, but several friends have said they think it is. What is it, what is known about long term side effects? I know about the short term side effects -- I have used it and it helps, but I notice jitters and rapid heartbeat in my baby for a while after taking it. What are the consequences of not treating a wheeze that doesn't seem to cause discomfort to the baby? (3) One posting from the past said homeopathy can be effective. Has anyone used homeopathy for an infant with wheezing or asthma? Any recommendations for specific homeopaths in the East Bay?
Thanks for any input or advice to a worried Mom!!

I have had asthma since I was two, and my son gets it occasionally when he has a cold. It is very common for children under 3 to get asthma, and it doesn't necessarily mean they will have it when they get older.

Albuterol is a bronchodilator, not a steroid (although inhaled steroids are also considered safe, since very little reaches the bloodstream). Albuterol essentially stimulates the nervous system (like adrenaline), and causes the body to stop closing up the airway. I've heard coffee can help in a pinch (but I always carry my inhaler!) When I take it, my heart races, and my son has difficulty sleeping and night terrors.

Wheezing or coughing is a symptom of asthma. Asthma is inflammation and narrowing of the bronchial tubes. Asthma is hard to diagnose yourself. Sometimes in babies, wheezing can be caused by mucus in the upper respiratory tract, which is not asthma. The doctor needs to listen to the lungs to tell if it is asthma. My son doesn't get wheezing at all, just a cough.

My experience with asthma is that the more aggressively you treat it, the less likely it is to become chronic or debilitating. The lungs "learn" to get reactive, and the more they react, the more reactive they get. I use albuterol with my son whenever his asthma flares up and it doesn't last long (or happen often). For myself, if I need much albuterol I use an inhaled steroid to calm down the lungs, and I haven't had a serious attack since I was a kid. I have heard good things about homeopathy and chinese herbs in treating asthma. Apparently, the less time you've had asthma, the more effectively it can be treated.

Other important things you can do to avoid long-term asthma: use an air filter in the baby's room, don't have carpets or rugs, make sure all bedding and stuffed animals in the crib are washed regularly in hot water, make sure there's no mildew on the windows, and keep any animals out of the baby's sleeping area. Good luck! Meri

My son, who is now 1 year old, has had asthma almost his entire life. I kept taking him to the doctor because of the wheezing, then I noticed not only wheezing but a cough that would not go away. The doctors at kaiser prescribed albuterol, told me about the side affects, and told me the pros outweigh the cons. Yes hyperactivity and accelerated heart beat are common but if your child is wheezing it's because s/he is having difficulty breathing. Kaiser offers an asthma clinic class and what I understand is that the wheezing is due to swollen bronchial tubes or airways. While the wheezing itself isn't actually the asthma flare up, it is a sign that one could be on it's way. I don't know about home remedies. If you really don't want to give your child the albuterol then you should try it. However, if it doesn't work right away, I would give the albuterol.

If your a Member of Kaiser, ask to be enrolled in the class/clinic. You may have to fight with them because doctors "don't like to diagnose asthma in babies" but I think it's worth the headache. If you're not a member of Kaiser, email me and I'll be glad to share all the written information I got at the class. I wish good health for your child. Lucretia

If you go to the Health section of any big bookstore you will find several good books on the subject. I owned Children With Asthma several times, but kept giving it to people who need it more than I did.

Wheezing is a symptom of asthma. Don't ignore it, and don't wait to treat it until it seems more serious. By following your doctors instructions you should be able to avoid asthma related emergencies entirely... and you want to do that. Asthma flares are scarey, and they are dangerous.

Albuterol is NOT a steroid, and has a whole lot fewer side effects than a major asthma flare, so please don't worry about it too much. The beauty of inhaled asthma drugs is that they reach the lungs without being sidetracked through the bloodstream and/or stomach. Therefore the side effects are really minimal.

My son was given an albuterol liquid as an infant and handled it without problem, too. (Remember 30 years ago when they used to give adrenaline products for asthma? Now that was exciting). Perhaps the most encouraging thing I can tell you is that each of my kids was treated -- once -- for asthma, and never again (so far). Since I've been asthmatic for 20 years I was hyper about watching them breath as infants... and they outgrew their tiny, twitchy, bronchial tubes by the end of the first year and a half. Heather

Although my children don't have asthma (thankfully) I have had it my whole life and have a few observations I hope are helpful. It is important to treat asthma. Albuterol is not a steroid, it is a broncho-dilator. The steroid drug I am familiar with is called Azmacort--I think there are some others ones out there. Steroids tends to suppress the irritation and swelling in the lungs; albuterol actually dilates the bronchial tubes. Usually, a combination of the two is effective in treating asthma. Untreated asthma can lead to chronic problems and a whole host of other problems. My asthma wasn't diagnosed until high school and I KNOW I had it as a child--I have memories of severe attacks. As a result, I participated very little in certain sports that required running, got terrible coughs/colds, etc. In addition, asthma and allergies are closely related, and although an infant is too young to get tested for allergies, there are some common environmental allergens you might be able to mitigate--dust, cats, mold, etc.

My more important observation is that I have been doing accupunture for about four months to help with asthma (after trying homeopathy twice with two different practitioners) and my overall health, my allergies, and asthma are GREATLY improved. I see Dr. Zeiger, who is also an Oriental Medical Doctor and has other treatments in addition to accupunture. Someone suggested I do accupunture years ago--I was too freaked out by the needle idea and didn't--I really wish I had done this years ago. The needles are so much not a big deal, and in any case, I'm sure he or another practitioner would have something besides needles to offer an infant. Hope this helps, good luck! Meghan

Hi there to the Worried Mom with her little baby who wheezes, I am a nurse who has practiced in the Pediatric-Neonatal arena for about 12 years. Although I am not a physician I do have a few thoughts to offer. True, wheezing is never normal. The best way to find out at home if your little one is truly wheezing is to use a stethescope and listen to the front and back of her/his chest. You will hear high pitched sounds mostly when he/she inhales. In the beginning of my practice as a nurse and more recently as my career as a mom of a 4 and 5 1/2 year old, I found that stuffy noses can sometimes "whistle". We are a talented species. That whistling is not true wheezing.

I would highly recommend that you get the attention of your pediatrician and or nursepractitioner (sometimes health/disease education is easier to obtain from nurses who specialize in the area). Make sure your written list of questions is handy when you make a visit with your little one. Ask him/her to show you how to use a stethascope, and what the physical signs of wheezing are. This is *not* to replace their expert care but to include you in the team that is caring for your child. There is literally truckloads of information on Asthma, and other lung problems if that is even what your child has.

We also try to make a "whole person" assessment when trying to find out what is going on with little patients. The following is a short list of some other things to look for and think about.

-other signs of difficulty with breathing i.e. nostrils flaring, presence of a cold or other respiratory illness, fussiness, poor appetite, cough (often asthma "hides" as a chronic cough in children), vomiting with coughing, decreased activity, something called "retractions" or the uses of accessory chest muscles to help breath. This looks like the skin above, below and between the ribs being sucked in with each breath.

*Severe respiratory trouble or distress is a medical emergency. Call 911*

-possibility that asthma may be the problem. Asthma can be a devestating disease. Another more modern term for Asthma is Reactive Airway Disease or RAD. Your pediatrician will be able, hopefully, to assess and diagnose and if necessary treat with albuterol, steriods, and suggest environmental and nutritional interventions as well. Pediatric Pulmonologists are specialists in lung health and disease.

Albuterol is not a steroid but a brochopulmonary dialator - it opens up the airways that reach deep into the lungs. Sometimes those airways constrict due to irritation, infection, asthma and albuterol is one of several medications that can be used to treat RAD. Can be a liquid or an inhaled mist. Theophylline or Aminophylline are also potent airway dialators. Steroids, prednisone or its relatives, are NOT anabolic steroids that are often abused by athletes. They are used to decrease inflamation that can make airways more constricted. They work really well but do present some problems with long term use. The steriods have side effects that need to be weighed against the benefits especially in kids.

-"simple" household allergies may be a factor after all, Asthma can be defined loosely as a case of very severe allergies.

I have written a longer post than I meant to, but I hope that the general information helps. Always, always, always check with your pediatrition, repeatedly if necessary, to safeguard the health of your little one.

Regards and good luck, Lu

I am no expert on asthma & wheezing in babies, but I have been learning about it for the past 3 months when my (then) 7 month old was hospitalized overnight for wheezing. He is now 10 months. Basically, my Dr explained to me that wheezing is the same thing as asthma...asthma just means wheezing. He said I should not get lost in all the semantics & jargon. From what I understand, in the past doctors were reluctant to use the word "asthma" at such an early age & instead called the wheezing "reactive airways disease". Meg Zweiback, a pediatric nurse, told me that in the "old days" they did not treat the wheezing at this early age as aggressively, but now they are quick to pull out the nebulizer & albuterol. Meg told me that this early aggressive treatment is leading to the wheezing going away sooner. Several doctors explained to me that in a baby the air passageways are very small & that is why wheezing is common in babies. As they get older many or most cases disappear. My pediatrician told me that that was the good news but the bad news is that it was probably going to be a rough winter (he said this in November) because my son would likely wheeze when he gets a cold. So far he has been right.

You asked about albuterol is NOT a steroid. My son was given a few days of a steroid called prednizone back when he was hospitalized. You wouldn't want to use it daily but a few days is not a big deal. You might want to ask your Dr about a medicine called Cromolyn (Intal)....we mix this with Albuterol & put it in the nebulizer....Intal has no side effects & is very effective. By the way...if you are using a nebulizer, it is important to use the mask & not just wave the mist in front of the face. I was avoiding the mask because my son HATED it but was recently at the Dr & she really explained to me how important the mask gets less than half the medicine without it.

A good book is "Children with Asthma" by Thomas Plaut....but to tell you the truth I have only skimmed it as I am relucctant to accept that my son will become a "child with asthma" & there is little in the book about babies.

You asked about consequences of not treating the wheeze...I had asked my Dr about that too....even on the day that my son was hospitalized he did not seem in any major distress. I was told that if wheezing gets bad it interferes with oxygen getting to the blood & that is not good for the brain or any vital organs. My Dr has me treating with a nebulizer twice a day even when my son is not ill or wheezing...he believes that this can prevent more serious episodes. My Dr. (Dr. Howard Gruber) is fantastic & has a lot of experience with this. Ruth

My kids don't have asthma, but I do and can answer some of your questions. Asthma has three components: (1) bronchospasm (tightening of the bronchi); (2) swelling of the walls of the bronchi; and (3) formation of mucous "plugs" in the alveoli (air sacs). Different medications work on different aspects of the disease. Your doctor is correct that Albuterol is not a steroid. It is a bronchodilator, which works on first problem. It works immediately when inhaled, relaxing the smooth muscle tissue in the bronchi and reducing the constriction. (Imagine a tube that tightens; albuterol releases it again.) There are other drugs that are inhaled and are steroidal, like Flovent and Vanceril. They are used preventively to address the second problem -- bronchial swelling -- but will not work immediately to stop an asthma flareup. Albuterol can give a bit of a jittery feeling; obviously talk to your doctor about proper use and dosing for little kids. But in my experience, the jitters are a small price to pay for the ability to breathe. For what it is worth, my nephew had asthma as a baby, and my brother and sister-in-law spend hours with him using a nebulizer (with albuterol). He grew out of it and is a strapping healthy 13-year-old now. Good luck. Leslie

Asthma is a very dangerous and complicated condition. Many people seem to think it is not that serious but I have learned otherwise. My daughter has asthma. There is an ad campaign from the United Way that is trying to share more information about the possible impact of asthma that states, "Mikey's Mom didn't know asthma could kill..." I read the story of this little boy recently in "Allergy and Asthma Health: The Official Magazine of Allergy and Asthma Network, Mothers of Asthmatics, Inc." I am not trying to alarm you but it is important that more of us become educated about this, and related conditions. It is very important to obtain up-to-date information and dispel myths.

For example, many people think that asthma is usually outgrown. This may or may not be the case. Research in this area is revealing new data at an incredible rate. Be sure the doctor you are seeing has current information.

You can contact the Allergy and Asthma Network, Mothers of Asthmatics, Inc. by calling 800-878-4403. You can also call Lung Line 800-222-LUNG. The Children's Hospital Advice Nurses have given me some very valuable information, as well. Their number is 510-428-3007. Morgan

Albuterol for son's Restrictive Airway Disorder?

Jan 1997

My son was just diagnosed with Restrictive Airway Disorder, our doctor says that it can be a precursor to Asthma. We started giving him a liquid medicine last night called Abuterol, it makes him really hyper, and makes me a little worried. Do any of you have any experience with this disorder? I am told it is quite common in children, your advice would be appreciated.

I have one child who was diagnosed with asthma at age 6, so I'm familiar with all the meds, including albuterol elixir. The bronchodilators do make you hyper, especially those that are taken by liquid or pill, rather than inhaled directly into the lungs. Are you seeing an allergist/asthma specialist? It made a big difference to us to have the management of Benjamin's asthma turned over from the pediatrician to a specialist. There's going to be a big event about asthma in SF (at the Moscone Convention Ctr.?) on Saturday, Feb. 22, with lots of seminars about respiratory matters. I don't remember that there was much of an entrance fee.

Something on which I've spent way too much time as a parent! Not only only do I have two (of three) kids with this diagnosis, one of them is in the SPIRITED category (remember that discussion?). Liquid albuterol definitely not the thing for these kids.

My youngest sons first few years were exhausting: colds often became pneumonia, coughing kept the whole family up, he was so uncooperative about taking liquid medicines that even the nurse at the doctor's office admitted defeat. None of this was ever life threatening as I know asthma can be. We never ended up in the emergency room (though the Pediatric Advice Nurse at Kaiser and I developed a personal phone relationship) and we spent hours and hours and hours in urgent care.

I was always uncomfortable with the liquid albuterol, although I did not unconditionally say no to all drugs. I also tried lots of low tech stuff: steamy bathrooms, lots of water to drink, etc. In desperation I would sometimes start a course of albuterol, but things would deteriorate so rapidly (my son would be wild beyond imagining) that I would stop after only a few doses. I began to prefer the disease to the cure. One Kaiser doctor finally recommended that my son begin taking a sodium cromolyn (brand name Intal) inhaler. (You take this before you have a flare-up.) I truly felt this was a miracle drug. The first winter he took it, he didn't get pneumonia and he had only a couple of uncomfortable days and nights coughing. He liked inhaling (!) MUCH better than the sticky, sweet liquid medicines. It's been about four years: we've done different types and combinations of the inhaled medicines. We monitor peak flow. (Measures breathing difficulty and is very helpful in figuring out when to begin treating. I think using the meter cuts down on the use of the drugs.) We also have a nebulizer (a kind compressor, it delivers the stuff more effectively. It's how they treat them when you bring them in to the doctor's office.)

There are some good books out there about this. I liked one called (I think) Your Child and Asthma. But Kaiser's handouts are pretty good, too. (They are short and to the point.) Everyone seems to focus on self management, teaching the kids to recognize symptoms, independence.

(My older daughter, also with asthma, carries her inhaler with her, goes on long backpacking trips and plays field hockey. Managing it is, mostly, her responsibility.)

Good Luck!

My 4 1/2 year old son has chronic asthma. I have spent many sleepless nights giving him breathing treatments. Abuterol is the main drug given to children to deal with an asthma flair up. There are other drugs dispensed in inhalers that do not cause the hyperness. Hopefully this is only a single episode and is resolved quickly. If your child continues to have respiratory problems you should ask your pediatrician about Intol. Intol is a non-steroidal medicine that controls asthma and it works fairly well for a lot of children.

There are a lot of www sites that deal with asthma and local support groups. I could go on and on. If you need more information please contact me.


My daughter has had asthma for several years now. Abuterol is probably the most common medication prescribed for swollen or restricted airways. It has two common side effects: jitteriness and stomach irritation. It's called a bronchodilator medication. I've seen it in three versions. The liquid I've used is put in a nebulizing machine that vaporizes it while the child breathes through a mask or tube. For a few years my daughter used it in capsule form through a little device called a rotohaler. The powder from the capsule is fanned into the airways as the child breathes in and out. Then there are inhalers that dispense puffs of medication that the child then breathes in. I haven't heard of any liquid version that is swallowed. If your son is getting hyper from it his dose may be too high. My daughter only gets the side effects if one dose (in her case about three puffs from an inhaler) doesn't stop her wheezing and she needs to take several more doses. They usually determine dose by body weight.

You might want to have your child allergy tested. If the problem is caused by allergies, such as dust mites, probably the most common, you may want to make some changes in your child's bedroom and your house. My daughter saw Dr. James Nicholsen in Oakland. She still remembers the tests as being fun and him as being very nice. If allergies are causing it, taking care of the causes may prevent it from developing into asthma. If it isn't related to allergies, I've been told that kids can outgrow it.

Finally, you might want to call The American Lung Association in Oakland for more information. They offer classes for adults and kids with breathing problems and they run a week long summer camp for kids with asthma that my daughter really enjoyed. It's very reasonably priced. Also, because she took a workshop through the Lung Association that was paid for by my health insurance, the day camp was free, though I think it only costs about $50.00 for the week anyway.

AS for the jitteriness, the doctor suggested tylenol and a warm bath for their calming effects.

Hope this helps.


My name is Tri and yes I have had experience with the medication Abuterol. About 4 year ago my daughter who is now 7 was diagnosed with a mild case of asthma, and she was give the abuterol liquid and the abuterol inhaler. Yes it does make them hyper but it works, but I found that after a few dosages of the medication they sort of get used to it. I also find that my daughter is growing out of the wheezing or asthma as she is getting older. So don't worry, abuterol is a good medication.


RE: Restricted Airways Disorder and asthma. My son had something similar when he was a child. He was put on albuterol as well as a few other medications. I would suggest that you read the web pages on the internet regarding this drug as well as contact the American Lung Association and the Jewish Asthma Foundation (I believe that is the correct name). My child stayed on those drugs through elementary school and I am convinced that he had permanent hyper behavior as a result. However, he was taking albuterol and the other drugs daily. You did not say how old your child was or whether he is taking the medication daily. I think that it is important that you ensure that this medication regimen is the best for your child. By the way, my experience with the public school system while he was taking the medications daily was unsympathetic.


o folks with kids with asthma: my daughter (18 months) showed some early signs of asthma, which has been a real problem for her older sister (age 5). At first I tried abuterol. I was not comfortable with this as a long-term plan. The second time I took her to the M.D. we see who is also a homeopath. That worked quite well. Children often respond well to homeopathy (better than adults, often). Homeopathy prompts the body to heal itself, rather than just managing symptoms (which of course can be extremely valuable. I have asthma myself and have found managing symptoms essential to be able to work, parent, etc.)


I would agree strongly with the parents who indicated that seeing a specialist made a big difference in their ability to manage their child's asthma. There is no one-size-fits-all advice for asthma or anything else but if you doubt that your pediatrician is adequately handling your child's asthma, the medications involved, or your own anxiety related to the condition, press forward and find a specialist. Trust yourself.

I concur, too with the parent who recommended Dr. James Nickelsen (allergy, immunology & chronic respiratory diseases - 2320 Woolsey Street - 644-2316). I cannot say enough about his experience, intuition, and dedication to patients.

We also see Dr. Roger Morrison at the Hahnemahn Clinic, an M.D. and a homeopathic practicioner (and former asthma-sufferer).

My son's asthma, which began when he was 2.5 yrs, was allergy-induced and very severe. Almost a year later, after months of twice-daily albuterol treatments via nebulizer, and two terrifying hospitalizations, we finally found Nickelsen. The American Lung Assn course (a Saturday morning in Oakland & free of charge) was also quite helpful. The only book I found worthwhile was Children With Asthma by Plaut.