INTRAVENOUS AMINOPHYLLINE CONFERS NO BENEFIT IN ACUTE ASTHMA TREATED WITH INTRAVENOUS STEROIDS AND INHALED BRONCHODILATORS

Background. The role of intravenous aminophylline in acute asthma is u nclear despite meta-analysis of many studies comparing aminophylline w ith other bronchodilator therapies. Aims: The aim of this study is to determine whether continuous aminophylline infusion confers any benefi t in acute severe asthmatics treated with intravenous steroids and inh aled bronchodilators. Methods: The study was randomised, double-blind and placebo-controlled. All patients received nebulised salbutamol (1 mL of 0.5%) and ipratropium bromide (1 mL of 0.025%) with glycol dilue nt (1 mL) at 0, two, four, six, eight and 12 hours, and six-hourly the reafter. In addition all patients were given intravenous hydrocortison e 250 mg six-hourly and oxygen to maintain normoxia. Aminophylline,inf usions were adjusted to maintain therapeutic levels. Peak expiratory f low rate (PEFR) was measured before and after nebulised bronchodilator on a two-hourly basis in the Emergency Department (ED) and six-hourly on the inpatient wards. Results: Thirty-one patients were clinically sufficiently improved within 12 hours to be discharged home from the E D. The remaining 28 patients were admitted to the inpatient ward for a total trial duration of 48 hours. No significant difference was found between the placebo and treatment groups for measurements of PEFR, or for the duration of stay of the patients in hospital. The power of th e study was 80% for a 25% to 33% difference at a 5% level of significa nce. Presentation values of PEFR and arterial blood gases did not pred ict which patients would require inpatient admission and which could b e safely discharged home from the ED.