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An evaluation of theophylline dosing. Suggested by the Saudi national protocol for children with severe asthma
1Drug Monitoring Unit, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. dmukauh@yahoo.com
Insights
The Saudi national protocol improved theophylline use in children with severe asthma, with 70% achieving therapeutic levels. This study recommends individualized dosing based on drug levels for better asthma management.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
Background:
- Severe asthma management in children requires precise medication dosing.
- Theophylline is a key bronchodilator, but its narrow therapeutic index necessitates careful monitoring.
- Optimizing theophylline use is crucial for effective severe asthma control in pediatric patients.
Purpose of the Study:
- To assess the Saudi national protocol's effectiveness in optimizing theophylline use for severe pediatric asthma.
- To analyze theophylline clearance in children and establish guidelines for individualized dosing.
- To improve therapeutic outcomes for children with severe asthma through better theophylline management.
Main Methods:
- Blood theophylline levels were measured in 66 children with severe asthma.
- Patients were grouped based on adherence to Saudi national protocol dosing recommendations.
- Theophylline clearance was calculated using steady-state levels and pharmacokinetic equations.
Main Results:
- 70% of patients on protocol-recommended doses achieved therapeutic theophylline levels, compared to 10% in the under-dosed group.
- Theophylline clearance was significantly higher in younger children (1-8 years) than in older children (9-13 years).
- Mean theophylline clearance was 0.092 L/hr/kg in younger children and 0.069 L/hr/kg in older children.
Conclusions:
- The Saudi national protocol positively impacted theophylline optimization in severe pediatric asthma.
- Individualized theophylline dosing, guided by drug level monitoring, is recommended for optimal therapeutic effects.
- Age-specific clearance data supports tailored dosing strategies for pediatric asthma patients.
Objective:
To evaluate the impact of Saudi national protocol on the diagnosis and management of asthma for optimizing theophylline use in children with severe asthma. To also review theophylline clearance and provide guidelines for individualization of doses.
Methods:
Theophylline level was estimated in blood samples of 66 children with severe asthma who were admitted to King Abdulaziz University Hospital during the period 1998-1999. The theophylline doses given to these patients was reviewed and patients were categorized into 2 groups: Group one had received doses recommended by Saudi national protocol +/- 10%, group 2 had received doses <90% of that recommended by Saudi national protocol. The distribution of theophylline levels in blood samples of each group was estimated. Theophylline steady state level was used to estimate theophylline clearance using a standard pharmacokinetic equation.
Results:
Out of the total samples from group one, 70% of theophylline levels were within therapeutic range, while only 10% of the total samples of group 2 were within therapeutic range. The mean theophylline clearance in children (1-8 years) was estimated as 0.092 +/- 0.023 and was found significantly higher than the mean theophylline clearance (0.069 +/- 0.014) which is observed in older children (9-13 years).
Conclusion:
Saudi national protocol theophylline dose guidelines had a favorable impact on the optimization of theophylline use in children with severe asthma. Guidelines that ensure accurate adjustment of doses on individual basis in view of drug level were suggested.