Asthma: acute exacerbation: intravenous aminophylline did not improve peak flows.

The study

• Patients: severe acute asthma
• Intervention: intravenous aminophylline compared with albuterol, epinephrine or other bronchodilators
• Outcome: peak expiratory flow rate at one hour


Articles found in all using various medical databases- not stated, 1966 to 1986 (search terms: 'aminophylline' and 'asthma' ) and Bibliographies were also searched, authors and experts contacted for unpublished studies or other relevant articles. A manual search of Index Medicus was performed.

Selection criteria: as above
Appraisal criteria: selected by three independent reviewers using set criteria (detailed in text)
Articles excluded if:
• no concurrent controls
• no original data
• not acute asthma
• duplicate of another report
• no spirometric outcome data


Thirteen studies were found- all were randomised and at least single-blinded
No significant heterogeneity was found.

The evidence

• effect size: relative increase in FEV1 for the aminophylline group compared with control: -0.16 (95% CI: -0.93 to 0.61)

Comments

1. All the studies were small, used different drugs and had very short follow-up. Aminophylline may have longer-term effects not detected by these studies.
2. There were few reported side-effects. Those that did suggested an increase in nausea, vomiting, palpitations and tremor in patients on aminophylline.
3. Clinically relevant outcomes - time to discharge, intubations etc - are needed before firm conclusions are arrived at.



Citation

1. Littenberg B, : aminophylline treatment in severe, acute asthma: a meta-analysis. Journal of the American Medical Association 1988; 259 (11): 1678-1684
Search Terms: acute asthma in Cochrane
Contributor: Chris Ball and Clare Wotton, November 2000
Reviewer: Mitsuhiro Kamei

_{Clinical Question.}

Patient	acute asthma
Intervention or Exposure	intravenous aminophylline
Comparison	other drugs
Outcome	peak flow