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Evidence summaries

Intravenous Aminophylline for Severe Acute Asthma in Children

Intravenous aminophylline improves lung function in children with a severe asthma exacerbation when added to beeta2-agonists and glucocorticoids but does not reduce the length of hospital stay. Risk of vomiting is significantly increased. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 7 studies with a total of 380 children with severe acute asthma already receiving oxygen, maximised inhaled bronchodilators and systemic glucocorticoids. Aminophylline significantly improved percentage predicted FEV1 compared to placebo at 6-8 hours (8.37% predicted, 95% CI 0.82 to 15.92; 2 trials); the effect was sustained at 24 hours (8.87% predicted, 95% CI 1.25 to 16.50; 2 trials). Improvement in PEF was also significant at 6-8 hours (SMD 0.62, 95% CI 0.04 to 1.2) but not at 24 hours (SMD 0.39, 95% CI -0.51 to 1.30).

Improvements were also seen in symptom scores in favour of aminophylline at 6-8 hours (SMD: -0.42, 95% CI -0.70 to -0.14; 2 trials) but not at 24 hours (SMD -0.13 95% CI -0.52 to 0.25; submaximal subgroup). There was no significant difference in length of hospital stay, symptoms, frequency of nebulisations and mechanical ventilation rates. Vomiting was more likely with aminophylline therapy (RR 3.59, 95% CI 2.15 to 6.33; 5 trials).

    References

    • Mitra A, Bassler D, Goodman K, Lasserson TJ, Ducharme FM. Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators. Cochrane Database Syst Rev 2005 Apr 18;(2):CD001276. [PubMed]

Primary/Secondary Keywords