Aminophylline Therapy for Acute Bronchospastic Disease in the Emergency Room

Abstract

▪ Objective: To assess the role of aminophylline in the treatment of acute exacerbations of bronchospastic disease when used in addition to inhaled beta-agonists and intravenous corticosteroids.

▪ Design: Randomized, double-blind, placebo-controlled intervention study.

▪ Patients: One hundred thirty-three adult patients with either asthma or chronic obstructive pulmonary disease who presented to the emergency department with asthma or wheezing.

▪ Interventions: All patients received therapy with both aerosolized metaproterenol and intravenous methylprednisolone. Patients were randomly assigned to receive either a loading dose of aminophylline followed by a routine infusion (n = 65) or an equal volume of placebo as a loading dose and infusion (n = 68).

▪ Measurements and Main Results: At discharge from the emergency department, the median serum theophylline concentration for the aminophylline group was 54 µmol/L (9.7 mg/L). The two groups showed no differences (P > 0.2) in measurements of forced expiratory volume at 1 second (FEV₁), forced vital capacity (FVC), or peak expiratory flow rate (PEFR) at baseline or at 60 or 120 minutes after aminophylline administration. Neither patient satisfaction nor physician assessment of response to therapy differed between the two groups. There was no difference (P > 0.2) in the frequency of side effects, except for a trend toward a higher frequency of nausea (P = 0.13) in the aminophylline group. There was, however, a threefold decrease in the hospital admission rate for patients treated with aminophylline (6%) compared with placebo recipients (21%) (P = 0.016).

▪ Conclusion: Aminophylline, in doses producing levels just below the commonly accepted therapeutic range, appears to decrease hospital admissions in patients with acute exacerbation of asthma or chronic obstructive pulmonary disease. This finding, if confirmed in larger studies, may represent a substantial cost savings.