The benefit of aminophylline in the management of acute asthma is controversial. Several clinical trials have found that aminophylline contributes little to the improvement of spirometric measures when adequate beta-adrenergic therapy is already being given. Murphy and associates studied the effect of aminophylline on peak expiratory flow rates in patients with acute asthma.
The study group consisted of 44 patients who presented with an acute exacerbation of a previously diagnosed asthmatic condition and whose peak expiratory flow rate remained less than 40 percent of the predicted value after an initial treatment with metaproterenol sulfate. Patients were given an intravenous dose of methylprednisolone sodium succinate, and a baseline serum theophylline level was determined. If the theophylline level was less than 28 [mu]mol per L, patients were randomized to receive either aminophylline or placebo. A bolus infusion was given, followed by a maintenance drip. All patients received nebulized metaproterenol each hour. The peak expiratory flow rate was measured every hour for five hours.
No difference or improvement in the peak expiratory flow rate was apparent in either group at any time during the five-hour study period. The improvement in peak expiratory flow rate from the time of administration of the study drug until the end point was identical for both groups.
Members of the group that received aminophylline had a greater incidence of tremor, palpitations, and nausea and vomiting than members of the placebo-treated group. A patient receiving aminophylline was 10 times more likely to have tremor or nervousness, 4.4 times more likely to have palpitations and 8.3 times more likely to experience nausea and vomiting than a patient receiving placebo. None of the members of either group experienced significant headache.
The authors conclude that aminophylline contributes no additional benefit as measured by improvement in peak expiratory flow rate in the treatment of patients with acute asthma who are given beta-adrenergic, agents and corticosteroids by inhalation. Aminophylline therapy in these patients also causes significantly more side effects.
The authors note that most members of the study group were young men from the inner city who did not regularly take aminophylline. These individuals should have benefited from aminophylline therapy since their aminophylline levels were low at presentation, but no response was achieved. Aminophylline could have been expected to contribute to improvement in Peak expiratory flow rate since metoproterenol doses were provided hourly and not more frequently. The fact that the treatment group did not benefit from aminophylline suggests that patients who present with higher pretreatment theophylline levels and who receive more frequent nebulizers would have even less benefit from aminophylline therapy (Archives of Internal Medicine, August 9, 1993, vol. 153, p. 1784.)
COPYRIGHT 1994 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group
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