Aminophylline dosage in acute severe asthma

Gleeson, J. G. A.; Price, John

doi:10.1007/bf00441563

Cited by 3 publications

(1 citation statement)

References 8 publications

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“…Data suggests that a 5mg/kg loading dose would leave one third of children would be below 10mg/l, and none above 20mg/l [ 27 ] Routine measurement of serum theophylline levels in children suffering acute asthma who have received standard loading doses of aminophylline to achieve serum concentrations in the 10-20mg/L range is therefore unlikely to result in any clinical benefit or reduction in adverse effects. However measurement of serum theophylline in childhood acute severe asthma may still retain utility in the assessment of patients in whom there is concern about overdose.…”

Section: Discussionmentioning

confidence: 99%

The Evidence for Intravenous Theophylline Levels between 10-20mg/L in Children Suffering an Acute Exacerbation of Asthma: A Systematic Review

2016

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BackgroundIntravenous theophyllines are a second line treatment for children suffering an acute exacerbation of asthma. Various guidelines and formularies recommend aiming for serum theophylline levels between 10-20mg/l. This review aims to assess the evidence underpinning this recommendation.MethodsA systematic review comparing outcomes of children who achieved serum theophylline concentrations between 10-20mg/l with those who did not. Primary outcomes were time until resolution of symptoms, mortality and need for mechanical ventilation. Secondary outcomes were date until discharge criteria are met, actual discharge, adverse effects and FEV1.Data sourcesMEDLINE, CINAHL, CENTRAL and Web of Science. Search performed in October 2015.Eligibility criteriaInterventional or observational studies utilizing intravenous theophyllines for an acute exacerbation of asthma in children where serum theophylline levels and clinical outcomes were measured.Findings10 RCTs and 2 observational studies were included. Children with serum levels between 10-20mg/l did not have a reduction in duration of symptoms, length of hospital stay or need for mechanical ventilation or better spirometric results compared with levels <10mg/l. Levels above 20mg/l are not associated with higher rates of adverse effects. This study is limited due to heterogeneity in the way theophylline levels were reported and poor surveillance of adverse effects across studies.ConclusionDosing strategies aiming for levels between 10-20mg/l are not associated with better outcomes. Clinicians should rely on clinical outcomes and not serum levels when using intravenous theophyllines in children suffering an acute exacerbation of asthma.

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Section: Discussionmentioning

confidence: 99%

The Evidence for Intravenous Theophylline Levels between 10-20mg/L in Children Suffering an Acute Exacerbation of Asthma: A Systematic Review

2016

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Precision Dosing in Children

Hawcutt

Cooney

Oni

et al. 2016

Expert Review of Precision Medicine and Drug Development

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Aminophylline Dosage In Asthma Exacerbations in Children: A Systematic Review

Cooney¹,

Sinha²,

Hawcutt³

2016

PLoS ONE

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BackgroundAdequate asthma treatment of childhood exacerbations with IV aminophylline depends on appropriate dosage. Recommendations to aim for a target therapeutic range may be inappropriate as serum concentrations correlate poorly with clinical improvement. This review aims to evaluate the evidence for the optimum dosage strategy of intravenous aminophylline in children suffering an exacerbation of asthma.MethodsA systematic review comparing dosage regimens of intravenous aminophylline in children suffering an exacerbation of asthma. Primary outcomes were time until resolution of symptoms, mortality and need for mechanical ventilation. Secondary outcomes were date until discharge criteria are met, actual discharge and adverse effects.Data sourcesCENTRAL, CINAHL, MEDLINE and Web of Science. Search performed in March 2016Eligibility criteriaStudies using intravenous aminophylline in children with an acute exacerbation of asthma which reported the dosage and clinical outcomes.Findings14 RCTs were included. There is a poor relationship between the dosage administered to children and symptom resolution, length of stay or need for mechanical ventilation. This study is limited due to its use of indirect evidence.ConclusionThe currently recommended dosage regimens may not represent the optimum safety and efficacy of intravenous aminophylline. There is a need to develop the evidence base correlating dosage with patient centered clinical outcomes, to improve prescribing practices.

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Aminophylline dosage in acute severe asthma

Cited by 3 publications

References 8 publications

The Evidence for Intravenous Theophylline Levels between 10-20mg/L in Children Suffering an Acute Exacerbation of Asthma: A Systematic Review

The Evidence for Intravenous Theophylline Levels between 10-20mg/L in Children Suffering an Acute Exacerbation of Asthma: A Systematic Review

Precision Dosing in Children

Aminophylline Dosage In Asthma Exacerbations in Children: A Systematic Review

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