Treatment of acute asthma. Lack of therapeutic benefit and increase of the toxicity from aminophylline given in addition to high doses of salbutamol delivered by metered-dose inhaler with a spacer
- PMID: 7924475
- DOI: 10.1378/chest.106.4.1071
Treatment of acute asthma. Lack of therapeutic benefit and increase of the toxicity from aminophylline given in addition to high doses of salbutamol delivered by metered-dose inhaler with a spacer
Abstract
We conducted a randomized, double-blind, placebo-controlled study to determine if intravenous aminophylline adds any benefit to high doses of inhaled salbutamol in patients who presented for treatment of acute asthma. We studied 94 patients (mean age, 35.6 +/- 11.2 years) with moderate to severe acute asthma. All patients received therapy with salbutamol delivered with metered-dose inhaler (MDI) into a spacer device (Volumatic) in four puffs (400 micrograms) at 10-min interval, and intravenous hydrocortisone (500 mg). Patients were randomly assigned to receive either a loading dose of intravenous aminophylline followed by a routine infusion (n = 45) or an equal volume of placebo as a loading dose and infusion (n = 49). The two groups showed no differences in measurements of peak expiratory flow, FEV1, and FVC at baseline and at the end of treatment. However, the patients treated with aminophylline had significantly more adverse effects (p < 0.05). There were no differences in the final mean dose of salbutamol (6.3 +/- 44.5 mg for the placebo group and 5.8 +/- 4.2 mg for the aminophylline group), hospital admission rate (10.2 percent for the placebo group and 9.0 percent for the aminophylline group), and mean duration of Emergency Department treatment (2.5 +/- 1.83 h for the placebo group and 2.37 +/- 1.75 h for the aminophylline group). The results were similar when the patients were divided in accord with the degree of respiratory obstruction (baseline FEV1 < 30 percent of predicted) and theophylline level at 30 min of treatment (placebo group patients with theophylline level < 10 mg/L vs aminophylline group patients with theophylline level > or = 10 mg/L). We conclude that intravenous aminophylline adds to the toxicity but not the efficacy of inhaled salbutamol in the treatment of acute exacerbations of asthma.
Comment in
-
Treating acute asthma.Chest. 1995 Aug;108(2):590-1. doi: 10.1378/chest.108.2.590-a. Chest. 1995. PMID: 7634917 No abstract available.
Similar articles
-
Inhaled albuterol and oral prednisone therapy in hospitalized adult asthmatics. Does aminophylline add any benefit?Chest. 1990 Dec;98(6):1317-21. doi: 10.1378/chest.98.6.1317. Chest. 1990. PMID: 2245667 Clinical Trial.
-
The Spacehaler for delivery of salbutamol: a comparison with the standard metered-dose inhaler plus Volumatic spacer device.Respir Med. 1997 May;91(5):311-6. doi: 10.1016/s0954-6111(97)90035-4. Respir Med. 1997. PMID: 9176650 Clinical Trial.
-
Salbutamol treatment of acute severe asthma in the ED: MDI versus hand-held nebulizer.Am J Emerg Med. 1998 Nov;16(7):637-42. doi: 10.1016/s0735-6757(98)90164-4. Am J Emerg Med. 1998. PMID: 9827736 Clinical Trial.
-
[Importance of other therapeutic medications administered parenterally in severe acute asthma].Ann Fr Anesth Reanim. 1998;17 Suppl 2:44s-47s. doi: 10.1016/s0750-7658(99)80022-7. Ann Fr Anesth Reanim. 1998. PMID: 9881208 Review. French.
-
Spacers and nebulisers for the delivery of beta-agonists in non-life-threatening acute asthma.Respir Med. 2003 Jul;97(7):762-9. doi: 10.1016/s0954-6111(03)00021-0. Respir Med. 2003. PMID: 12854625 Review.
Cited by
-
Addition of intravenous beta(2)-agonists to inhaled beta(2)-agonists for acute asthma.Cochrane Database Syst Rev. 2012 Dec 12;12(12):CD010179. doi: 10.1002/14651858.CD010179. Cochrane Database Syst Rev. 2012. PMID: 23235685 Free PMC article.
-
Randomised controlled trial of aminophylline for severe acute asthma.Arch Dis Child. 1998 Nov;79(5):405-10. doi: 10.1136/adc.79.5.405. Arch Dis Child. 1998. PMID: 10193252 Free PMC article. Clinical Trial.
-
Management of acute asthma in adults in the emergency department: nonventilatory management.CMAJ. 2010 Feb 9;182(2):E55-67. doi: 10.1503/cmaj.080072. Epub 2009 Oct 26. CMAJ. 2010. PMID: 19858243 Free PMC article. Review. No abstract available.
-
Salbutamol attenuates arrhythmogenic effect of aminophylline in a hPSC-derived cardiac model.Sci Rep. 2024 Nov 9;14(1):27399. doi: 10.1038/s41598-024-76846-4. Sci Rep. 2024. PMID: 39521810 Free PMC article.
-
Clinical review: severe asthma.Crit Care. 2002 Feb;6(1):30-44. doi: 10.1186/cc1451. Epub 2001 Nov 22. Crit Care. 2002. PMID: 11940264 Free PMC article. Review.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical