Therapy

• aminophylline iv ^d
  (e.g. a loading dose of 5.6 mg/kg over 20 min (not if patient has taken theophyllines within the last 24 hours), followed by continuous infusion 0.9 mg/kg per hour.) 

Why?

• It may reduce hospital admissions ^d  
• It reduces relapses ^b and the need for intubation or iv salbutamol in children with severe asthma ^a
• Patients require fewer nebulisers (on average 6 fewer at 48 hours) ^a , but there is no clear effect on pulmonary function tests for up to 2 hours. ^a
• However side-effects (tremor, nausea or vomiting, and palpitations) are common, and children on aminophylline are more likely to stop therapy due to adverse effects. ^a

Aminophylline reduces the need for intubation, but causes vomiting and palpitations

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
asthma exacerbation a	iv aminophylline	placebo	hospital admission at  hours	28%	0.57 (0.32 to 1.02)	10 (NNT = 6  to infinity; NNH = 250 to infinity)
			vomiting	9.0%	4.18 (2.38 to 7.36)	-5 (-10 to -3)
			arrhythmia/palpitations	10%	2.92 (1.49 to 5.70)	-7 (-23 to -3)
children with acute severe asthma a	iv aminophylline	placebo	iv salbutamol required at 48 hours	32%	42% (-2% to 67%)	8 (4 to 2800)
			intubation required at 48 hours	6.1%	100%	16 (9 to 110)
			therapy stopped due to side-effects at 48 hours	4.9%	-558% (-1700% to -140%)	-4 (-6 to -3)

Aminophylline reduces relapse in children.

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
children with acute asthma b	theophyllines in emergency department	no theophyllines	relapse at 10 days	55%	0.4 (0.2 to 0.8)	5 (3 to 18)