DOES AMINOPHYLLINE BENEFIT ADULTS ADMITTED TO THE HOSPITAL FOR AN ACUTE EXACERBATION OF ASTHMA

Objective: To determine the effect of adding intravenous theophylline (administered as aminophylline) to nebulizations of albuterol and intr avenous methylprednisolone in adults hospitalized for acute asthma. De sign: Randomized, placebo-controlled, double-blind study. Setting: Inp atient service of a tertiary-care, university teaching hospital. Patie nts: 21 adults (22 to 48 years old)-10 in the aminophylline group and 11 in the placebo group. Interventions: Nebulized albuterol, 2.5 or 5. 0 mg every 0.5 to 4 hours; intravenous methylprednisolone, 60 mg every 6 hours; and either individualized doses of aminophylline or placebo for 48 hours. Measurements: Forced expiratory volume in 1 second (FEV1 ), the number of ''as needed'' albuterol nebulizations and total dose, asthma symptom scores, and adverse effects. Results: At admission fro m the emergency department, the mean +/- SD baseline FEV1 was 49% +/- 19% of the predicted value in the aminophylline group and 43% +/- 13% of the predicted value in the placebo group. The improvement in FEV1 a t 3 hours was greater in the aminophylline group (29% +/- 23% compared with 10% +/- 10% in the placebo group; mean difference, 19 percentage points; 95% CI, 3 to 35 percentage points; P = 0.023). At 48 hours, F EV1 was 75% +/- 19% of the predicted value in the aminophylline group and 58% +/- 15% of the predicted value in the placebo group (mean diff erence, 17 percentage points; CI, 0.2 to 34.8 percentage points; P = 0 .048). Aminophylline-treated patients required fewer nebulizations of albuterol (10.3 +/- 3.8 compared with 16.4 +/- 5.3; mean difference, - 6.1; CI, -10.3 to -1.8) and less total dosage (34 +/- 16 mg compared w ith 70 +/- 34 mg; mean difference, -36 mg; CI, -60.6 to -11.3 mg P = 0 .02). No statistical differences were observed in asthma symptom score s or frequency of adverse effects. Conclusions: Individualized doses o f intravenous theophylline added to frequent nebulizations of albutero l and intravenous methylprednisolone appear to benefit adults admitted to the hospital with acute asthma and are well tolerated when serum c oncentrations are maintained in the therapeutic range.