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Efficacy of intravenously administered theophylline in children hospitalized with severe asthma
1Department of Pediatrics, University of Florida College of Medicine, Gainesville.
Insights
Adding theophylline to standard asthma treatments did not improve outcomes for hospitalized children with severe asthma. This study found no significant differences in lung function or recovery time when theophylline was used alongside albuterol and methylprednisolone.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
- Critical Care Medicine
Background:
- Severe asthma exacerbations in children require intensive inpatient management.
- Standard treatments include bronchodilators like albuterol and corticosteroids such as methylprednisolone.
- Theophylline is a bronchodilator with potential adjunctive benefits in asthma.
Purpose of the Study:
- To evaluate the efficacy of intravenous theophylline as an add-on therapy for severe pediatric asthma hospitalizations.
- To determine if theophylline improves clinical outcomes when combined with frequent nebulized albuterol and intravenous methylprednisolone.
Main Methods:
- A prospective, randomized, double-blind, placebo-controlled trial was conducted.
- Twenty-one children (5-18 years) with severe asthma received standard care plus either theophylline or placebo for 36 hours.
- Outcomes measured included forced expired volume in 1 second (FEV1), clinical scores, and hospital stay duration.
Main Results:
- Both the theophylline and placebo groups showed significant improvement in clinical scores and FEV1 within 12 and 24 hours, respectively.
- No significant differences were observed between the groups in FEV1, clinical scores, or duration of hospital stay.
- Adverse effects were mild, infrequent, and comparable between the theophylline and placebo groups.
Conclusions:
- Intravenously administered theophylline does not provide additional benefit for children hospitalized with severe asthma receiving frequent nebulized albuterol and intravenous methylprednisolone.
- Therapeutic concentrations of theophylline did not enhance recovery or alter outcomes in this specific treatment context.
- Further research may explore alternative adjunctive therapies for severe pediatric asthma.
Purpose:
To determine whether intravenously administered theophylline, when added to frequently nebulized albuterol and intravenously administered methylprednisolone, benefits children hospitalized with severe asthma.
Design:
Prospective, randomized, placebo-controlled, parallel-group, double-blind study.
Setting:
Inpatient pediatric service at a tertiary-care teaching hospital.
Patients:
Twenty-one children 5 to 18 years of age.
Interventions:
All patients received 2.5 to 5.0 mg of nebulized albuterol every 20 minutes to every 6 hours, intravenously administered methylprednisolone (1 mg/kg every 6 hours), and either intravenously administered theophylline (as aminophylline) or placebo for 36 hours. Serum theophylline concentrations were maintained between 55 and 110 mumol/L (between 10 and 20 micrograms/ml) by adjusting loading doses and continuous infusion rates.
Measurements And Main Results:
Forced expired volume in 1 second (FEV1) and clinical score were measured at 0, 1, 3, 6, 12, 24, and 36 hours after the start of each individual study. The total number of nebulizations, total albuterol dosage, adverse effects, and duration of hospital stay were recorded. Twelve children received theophylline and nine received placebo. The two groups did not differ significantly in age, sex, or baseline FEV1. In both groups, clinical score significantly improved from baseline by 12 hours, and FEV1 by 24 hours (p < 0.05). There were no significant differences between the groups in FEV1 or clinical score at any of the measured time points. There were no significant differences in rate of improvement in FEV1, total number of nebulizations, total albuterol dosage, or duration of hospital stay. Adverse effects were mild and infrequent and did not differ significantly between the two groups.
Conclusions:
Theophylline, at therapeutic concentrations, did not additionally benefit children hospitalized with severe asthma who were being treated frequently with nebulized albuterol and with methylprednisolone intravenously.
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