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Intravenous aminophylline for acute severe asthma in children over 2 years using inhaled bronchodilators
A Mitra1, D Bassler, F M Ducharme
1Ninewells Hospital, Dundee, Scotland, NHS.
Insights
Intravenous aminophylline improves lung function and symptoms in children with severe asthma. However, it increases the risk of vomiting and does not shorten hospital stays.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Pharmacology
Background:
- Intravenous aminophylline was a primary bronchodilator for acute pediatric asthma.
- Recent interest has resurfaced for its use in acute severe asthma.
- Current guidelines recommend other bronchodilators, but evidence for aminophylline's role is being re-evaluated.
Purpose of the Study:
- To evaluate the efficacy of adding intravenous aminophylline to standard treatment for acute severe asthma in children.
- To assess its impact on bronchodilation, symptom scores, and clinical outcomes.
- To determine if aminophylline offers benefits beyond oxygen, inhaled bronchodilators, and glucocorticoids.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) comparing intravenous aminophylline with placebo.
- Searched major databases (MEDLINE, EMBASE, CINAHL) and respiratory journals up to October 2000.
- Seven RCTs involving hospitalized school-aged children with severe asthma were included.
Main Results:
- Aminophylline significantly improved forced expiratory volume in 1 second (FEV1) by 8.4% at 6-8 hours, sustained for 24 hours.
- Symptom scores also showed improvement within 6-8 hours.
- No reduction in hospital stay or nebulizer use was observed.
- Increased likelihood of vomiting (RR=3.69) was associated with aminophylline.
Conclusions:
- Intravenous aminophylline can be considered for children hospitalized with severe asthma unresponsive to initial inhaled bronchodilators.
- Benefits include sustained improvement in lung function and symptoms for 24 hours.
- Aminophylline treatment is linked to a higher incidence of vomiting without reducing hospital length of stay or beta2-agonist use.
Background:
Intravenous aminophylline was the bronchodilator of choice for many years until supplanted by more effective bronchodilators in the treatment of acute paediatric asthma. Recently there has been renewed interest in this therapy for children with acute severe asthma.
Objectives:
To determine whether addition of intravenous aminophylline produces a beneficial effect in children with acute severe asthma receiving oxygen, maximised inhaled bronchodilators and oral/intravenous glucocorticoids.
Search Strategy:
The Cochrane Airways Group register of trials (based on MEDLINE, EMBASE, CINAHL and hand searched respiratory journals) and reference lists of relevant articles were used to identify relevant studies. The latest search was carried out in October 2000.
Selection Criteria:
Only randomised-controlled trials comparing intravenous aminophylline with placebo in children treated with inhaled bronchodilators and systemic glucocorticoids for acute asthma were considered for this review.
Data Collection And Analysis:
Full text of 35 trials were anonymized for author, date and publication and two blinded independent reviewers selected eligible studies for inclusion. Disagreement was resolved through consensus. Seven trials met the inclusion criteria. Attempts were made to contact authors to verify accuracy. Results were reported as weighted mean differences (WMD) or relative risk (RR) with 95% confidential intervals (CI).
Main Results:
Patients in these trials were predominantly school-aged children hospitalised for acute severe asthma with a baseline FEV1 at 35-40% of predicted and/or a baseline Pulmonary Index of 6-7. Aminophylline significantly improved percentage predicted FEV1 by 6 - 8 hours (WMD 8.4%; 95% CI: 0.82, 15.92%). The effect was maintained for 24 hours. Improvements were also seen in symptom scores at 6-8 hours (WMD= -0.71; 95% CI: -0.82,-0.60). There was no reduction in hospital stay or in number of nebulisers required. Vomiting was more likely with aminophylline therapy (Relative Risk = 3.69; 95% CI: 2.15, 6.33).
Reviewer'S Conclusions:
Addition of intravenous aminophylline should be considered early in the treatment of children hospitalised with acute severe asthma with sub optimal response to the initial inhaled bronchodilator therapy. Although the improvement is sustained for 24 hours, there is no apparent reduction in length of hospital stay or number of inhaled beta2-agonists nebulisations. Treatment with aminophylline is associated with an increased risk of vomiting.
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