Re-evaluation of the Efficacy and Safety of Aminophylline for Children with Acute Asthma Exacerbation

Youn, Unki; Choi, Jungi; Koh, Ji Yeon; Kim, Mun Seop; Kim, Hyo Bin; Fujisawa, Takao; Kim, Chang Keun

Abstract

PURPOSE: Although methylxanthines (aminophylline or theophylline) have an equivalent bronchodilator effect on inhaled beta2-agonists, the GINA guidelines recommend methylxanthines as an alternative to methylxanthines becamse of their side effects. The Japanese Pediatric Guidelines for the Treatment and Management of Asthma (JPGTMA 2005), however, recommends methylxanthines for the treatment of asthma attack along with systemic corticosteroids. We aimed to determine whether the addition of intravenous (IV) aminophylline with both IV corticosteroids and inhaled beta2-agonists would improve asthma symptoms better and earlier without serious adverse effects.
METHODS
Thirty-seven children with acute asthma exacerbation were studied. Twenty patients were treated with a combination of IV corticosteroids, inhaled beta2 agonists and IV aminophyllines (Group A), and 17 patients were treated with IV corticosteroids and inhaled beta2 agonists only (Group B). We evaluated the changes of symptom scores, including degrees of wheezing, retraction, orthopnea, cyanosis and SpO2, before and after treatment in both groups.
RESULTS
Group A patients showed faster improvement in asthma symptom score (P<0.05) and significantly faster resolution of wheezing (P<0.05) than Group B patients. In Group B, patients with prolonged wheezing (>72 hours) resulted in need for larger dose of systemic steroids (P<0.05). Although adverse effects occurred in 20% of Group A patients, all of which them were not serious without the need for drug withdrawal.
CONCLUSION
IV aminophylline may be a therapeutic option for children with acute asthma exacerbation. Further evidence is needed to substantiate the conclusion.