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Salivary theophylline monitoring in asthmatic children
L Orłowski1, D Paczkowski, J Podleśny
1Children Health Center, Department of Laboratory Diagnosis, Warszawa, Poland.
Insights
Saliva theophylline levels can reliably estimate serum concentrations in children with asthma. Bromhexine stimulation offers a more accurate method for routine theophylline monitoring during therapy.
Area of Science:
- Pharmacology
- Clinical Chemistry
- Pediatrics
Background:
- Theophylline is a crucial medication for managing asthma in children.
- Accurate monitoring of theophylline serum concentrations is essential for therapeutic efficacy and safety.
- Non-invasive methods for drug level determination are highly desirable in pediatric care.
Purpose of the Study:
- To evaluate the utility of salivary theophylline concentrations for estimating serum theophylline levels in asthmatic children.
- To compare the effectiveness of different saliva stimulation methods (citric acid vs. bromhexine) for this estimation.
- To assess the suitability of salivary theophylline measurement for routine therapeutic drug monitoring.
Main Methods:
- Asthmatic children receiving daily aminophylline (15-20 mg/kg) were enrolled.
- Theophylline concentrations were measured in both saliva and serum samples.
- Saliva samples were collected after stimulation with either citric acid or bromhexine.
- The ratio of saliva to serum theophylline concentrations was calculated and analyzed.
Main Results:
- A strong correlation was observed between salivary and serum theophylline concentrations.
- Bromhexine stimulation yielded a better correlation (r = 0.9496) compared to citric acid stimulation (r = 0.8506).
- Using a mean saliva:serum ratio of 0.6795, serum theophylline levels were predicted with high accuracy (r = 0.9810).
Conclusions:
- Salivary theophylline measurement, particularly after bromhexine stimulation, is a reliable and accurate method for estimating serum concentrations in asthmatic children.
- This non-invasive technique is suitable for routine therapeutic drug monitoring of theophylline.
- Bromhexine stimulation is preferred for its compatibility with systems like the Abbott TDX Drug Monitoring System.
Abstract:
The usefulness of determination of salivary concentrations of theophylline for estimation of the serum concentration of the drug was tested in asthmatic children receiving daily 15-20 mg/kg of aminophylline. Theophylline was measured in saliva samples obtained after stimulation with citric acid and bromhexine, and in the blood serum, and the ratio of saliva: serum theophylline concentrations was calculated. The correlation between saliva and serum theophylline concentration was better for saliva samples obtained after bromhexine stimulation (r = 0.9496) than after citric acid stimulation (r = 0.8506). Using the mean value of the saliva: tissue theophylline concentration ratio of 0.6795, the serum theophylline concentration may be satisfactorily predicted (r = 0.9810). The stimulation of salivation with bromhexine is more suitable for the Abbott TDX Drug Monitoring System than the stimulation with citric acid, and the method is suitable for a routine monitoring of theophylline concentrations in the course of theophylline therapy.