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Acceptance of domiciliary theophylline monitoring using dried blood spots
1Department of Chemical Pathology, Children's Hospital, Sheffield.
Insights
Most children with asthma complied with home monitoring for theophylline levels. However, only one-third of these children achieved therapeutic blood theophylline concentrations, indicating a need for better therapeutic drug monitoring.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacy
- Pharmacokinetics
Background:
- Theophylline is a common bronchodilator for asthma management.
- Accurate therapeutic drug monitoring is crucial for optimizing theophylline efficacy and minimizing toxicity.
- Home-based dried blood spot collection offers a convenient method for monitoring drug levels.
Purpose of the Study:
- To assess the feasibility of home-based dried blood spot collection for theophylline monitoring in pediatric asthma patients.
- To evaluate the proportion of pediatric asthma patients achieving therapeutic theophylline blood concentrations using this method.
Main Methods:
- 100 asthmatic children were sent kits for dried blood spot collection at home.
- 62 kits were returned and analyzed for theophylline concentrations.
- Theophylline levels were categorized as subtherapeutic, therapeutic, or potentially toxic.
Main Results:
- A compliance rate of 62% was observed for home-based dried blood spot collection.
- Only 34% of children achieved therapeutic theophylline blood concentrations.
- 61% had subtherapeutic levels, and 5% had potentially toxic levels.
Conclusions:
- Home monitoring of theophylline concentrations using dried blood spots is feasible in pediatric asthma patients.
- A significant majority of children on theophylline therapy do not achieve therapeutic blood concentrations.
- This highlights a potential gap in therapeutic drug monitoring and the need for improved management strategies.
Abstract:
Filter paper cards incorporating dried blood spots for the measurement of theophylline concentrations were returned by 62 out of 100 asthmatic children sent kits with instructions for their collection. Analysis of the blood spots showed that 37 (61%) of the children who returned them had less than therapeutic blood theophylline concentrations, in 21 (34%) they were therapeutic, and in three (5%) they were potentially toxic. The results indicate that most asthmatic children would comply with requests for home monitoring of theophylline concentrations, and that only one third of children receiving theophylline achieved blood concentrations and that only one third of children receiving theophylline achieved blood concentrations within the therapeutic range.