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Treatment of acute asthma in children with rectal administration of aminophylline solution
Insights
Rectal theophylline significantly improved peak flow in children with acute bronchoconstriction. Rapid absorption and good retention were observed, with bronchodilating effects noted at specific serum theophylline levels.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
Background:
- Acute bronchoconstriction in children requires effective and rapidly acting treatments.
- Theophylline is a bronchodilator with established efficacy, but rectal administration in pediatric populations requires further investigation.
Purpose of the Study:
- To evaluate the efficacy and pharmacokinetics of rectally administered theophylline in children with acute bronchoconstriction.
Main Methods:
- A double-blind, cross-over study involving 20 children with acute bronchoconstriction.
- Rectal administration of theophylline (9.0 mg/kg) or placebo, with a 90-minute interval.
- Peak expiratory flow (PEF) and serum theophylline levels were measured.
Main Results:
- A significant increase in PEF was observed 15 minutes after theophylline administration compared to placebo (p < 0.05).
- Bronchodilation was significant at serum theophylline levels around 7 mg/l.
- Rapid theophylline absorption occurred, with peak serum levels (7.3–16.0 mg/l) typically reached within 60 minutes.
- Good rectal retention and accurate dosage calculation were noted.
Conclusions:
- Rectal theophylline is an effective treatment for acute bronchoconstriction in children, demonstrating rapid absorption and bronchodilating effects.
- The rectal route offers a viable alternative for theophylline administration in pediatric patients.
- Further research into inter- and intrapatient variability in PEF response is warranted.
Abstract:
In a double-blind cross-over study, 20 children suffering from acute bronchoconstriction were treated with an interval of 90 min with placebo and 9.0 mg theophylline per kg given rectally in aqueous solution. Each child took part on 2 occasions. Fifteen min after both administrations of theophylline there was a significant increase in peak flow (PEF) as compared with placebo treatment (p less than 0.05). The increase in PEF was related to the serum level of theophylline, a significant bronchodilating effect was observed at about 7 mg/l. Substantial inter- and intrapatient variations were found in the improvement of PEF. The absorption of theophylline was rapid. The measured peak serum levels varied from 7.3 to 16.0 mg/l and occurred within 60 min in most patients. The intra-subject variations in the dose-to-dose absorption profiles were generally small and within a range acceptable for clinical use. The solutions allowed an accurate dosage calculation, did not initiate the urge to defecate, and were retained well.