A Controlled Trial of Intravenous Salbutamol and Aminophylline in Acute Asthma

Ae, Tribe; Wong, Ruby M.; Js, Robinson

doi:10.5694/j.1326-5377.1976.tb128275.x

Cited by 15 publications

(1 citation statement)

References 4 publications

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“…Our data show that in the context of usual emergency department treatment, IV theophylline is at least as effective as montelukast 28 and IV salbutamol. 23 , 34 …”

Section: Discussionmentioning

confidence: 99%

Efficacy and side effects of intravenous theophylline in acute asthma: a systematic review and meta-analysis

Mahemuti¹,

Zhang²,

Li³

et al. 2018

DDDT

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Background and objectiveTheophylline has been used for decades to treat both acute and chronic asthma. Despite its longevity in the practitioner’s formulary, no detailed meta-analysis has been performed to determine the conditions, including concomitant medications, under which theophylline should be used for acute exacerbations of asthma. We aimed to quantify the usefulness and side effects of theophylline with or without ethylene diamine (aminophylline) in acute asthma, with particular emphasis on patient subgroups, such as children, adults, and concomitant medications.MethodsWe searched PubMed, EMBASE, The Cochrane Library, ClinicalTrials.gov, and the WHO Clinical Trials Registry for randomized, controlled clinical trials. We planned a priori subgroup analyses by time post-medication, concomitant medication, control type, and age.ResultsWe included 52 study arms from 42 individual trials. Of these, 29 study arms included an active control, such as adrenaline, beta-2 agonists, or leukotriene receptor antagonists, and 23 study arms compared theophylline (with or without ethylene diamine) with placebo or no drug. Theophylline significantly reduced heart rate when compared with active control (p=0.01) and overall duration of stay (p=0.002), but beta-2 agonists were superior to theophylline at improving forced expiratory volume in one second (FEV1) (p=0.002). Theophylline was not significantly different from other drugs in its effects on respiratory rate, forced vital capacity (FVC), peak expiratory flow rate, admission rate, use of rescue medication, oxygen saturation, or symptom score. Closer examination of the data revealed that the medications given in addition to theophylline or control significantly changed the effectiveness of theophylline (subgroup difference: p<0.00001).ConclusionGiven the low cost of theophylline, and its similar efficacy and rate of side effects compared with other drugs, we suggest that theophylline, when given with bronchodilators with or without steroids, is a cost-effective and safe choice for acute asthma exacerbations.

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“…Our data show that in the context of usual emergency department treatment, IV theophylline is at least as effective as montelukast 28 and IV salbutamol. 23 , 34 …”

Section: Discussionmentioning

confidence: 99%

Efficacy and side effects of intravenous theophylline in acute asthma: a systematic review and meta-analysis

Mahemuti¹,

Zhang²,

Li³

et al. 2018

DDDT

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Aminophylline Treatment in Severe, Acute Asthma

Littenberg¹

1988

JAMA

127

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Aminophylline is routinely recommended as a basic part of the emergency treatment of asthma. A comprehensive search found 13 reports of controlled trials of intravenous aminophylline therapy in severe, acute asthma. These studies compared aminophylline therapy with treatment with either albuterol (salbutamol), epinephrine, or other bronchodilators. The 13 reports did not agree. Seven reported no difference in spirometric values between aminophylline treatment and the control regimens. Three found aminophylline treatment superior. Three favored the control regimen. The results of the 13 trials were reanalyzed and pooled. Overall, there was no difference between the aminophylline-treated groups and the control groups. Sensitivity analysis suggests that aminophylline therapy is ineffective alone but may be more effective than single-drug therapy when combined with an injected beta-agonist. Despite widespread practice, available trials do not provide adequate evidence to support or reject the use of aminophylline in the treatment of severe, acute asthma.

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