Aminophylline in the Emergency Department

Excerpt

To the Editors: Wrenn and colleagues (1) are to be congratulated for their important contribution to the emergency management of bronchospasm. Further study of aminophylline's clinical action, however, is necessary before changing emergency-room practice. How aminophylline prevents admissions is mysterious, because the drug decreases neither the severity of bronchospasm nor its symptoms (2). Subdividing exacerbations into "infectious, inflammatory, or allergic" categories, as the authors suggest, might identify predictors of admission and help explain the drug's mechanism.

The authors should consider measuring pulmonary function through the patient's emergency-room stay. Although improvement appears to level off after 2 hours, substantial airway obstruction