Vieira SE, Lotufo JP, Ejzenberg B, Okay Y. Efficacy of IV aminophylline as a supplemental therapy in moderate broncho-obstructive crisis in infants and preschool children. Our search strategy returned 1764 studies, with 38 full text articles assessed for eligibility. ASS asthma severity score, CAS/PI clinical asthma score/pulmonary index. Subgroup analyses were inadequately powered to detect the impact of baseline severity, serum aminophylline levels and intensity of cotreatment on the magnitude of effect. Sheih G, 0000002276 00000 n As no RCTs compare different aminophylline dosage in the treatment of childhood asthma exacerbations, this review is hindered by its use of indirect evidence. Intravenous aminophylline dosage. Separate meta analyses for each dosing regimen used would allow for a quantitative comparison of effect size between studies using random effects modeling. Baseline severity for each trial (including details of concomitant therapies used) is reported inTable 02. All but one study [31] prescribes aminophylline as a loading dose followed by an infusion. Nold JT, Chopra SC, Adequate reporting in two studies allowed quantitative data synthesis (Fig 3). Bien JP, Significant improvement in ventilatory function without observable adverse effects has been demonstrated by this double-blind controlled trial of intravenous aminophylline in status asthmaticus. Conflict of interest: Z. Shanta has nothing to disclose. THESE RECOMMENDATIONS SHOULD SERVE AS THE UPPER LIMIT FOR DOSE ADJUSTMENTS Adequate asthma treatment of childhood exacerbations with IV aminophylline depends on appropriate dosage. The optimal dosing of IV aminophylline in acute childhood asthma requires accurate assessment of its efficacy and adverse effects. There were no or insufficient data to examine any effect of treatment on oxygenation and avoidance of mechanical ventilation. Intravenous salbutamol bolus compared with an aminophylline infusion in children with severe asthma: a randomised controlled trial. Ream RS, 0000003503 00000 n Intravenous aminophylline was given as an initial bolus, followed by a continuous infusion with serum levels checked to ensure "therapeutic levels" in all eight studies. The dose must be individualized based on serum theophylline concentrations to achieve maximum benefit with minimal risk. Dose Regimens: Digiulio 1993 6mg/kg bolus 0.81.0mg/kg/h infusion, Ream 2001 7mg/kg bolus 0.50.8mg/kg/h infusion, Needleman 1995 6-8mg/kg bolus 0.81.0mg/kg/h infusion, Carter 1993 loading dose calculated on TDM infusion 0.81.0mg/kg/h, DAliva 2008 2 x 5mg/kg bolus, Strauss 1994 7mg/kg/h bolus 0.75 to 1.2 infusion. For inpatient studies, endpoints included the rate and duration of intubation and the duration of ICU/hospital admission. However there is no apparent reduction in symptoms, number of nebulised treatment and length of hospital stay. Mahajan R, We decided a priori that the most relevant study type would be a comparison of randomised controlled trials (RCTs) comparing different dosing strategies and measuring clinically relevant outcomes, but we would also include RCTs evaluating the efficacy of intravenous theophyllines compared with placebo or other treatment, with subsequent analyses performed for each comparator drug, and observational studies. Children were given oxygen, regular beta agonists and glucocorticoids from the outset in all the studies. However, at 24 hours there was no significant difference between treatment groups (SMD 0.13 95% CI: 0.52, 0.25; submaximal subgroup). %%EOF Theophylline and related drugs are often prescribed as modified-release formulations and toxicity can therefore be delayed. Jadad AR, Below, check out the tour dates, as well as a weird tour . The mean age of the children in all the studies was between 5 years and 9 years, except for Strauss 1994 where children were slightly older (mean age aminophylline group 11.5 years, placebo group 10.7 years). This double blind trial compares intravenous salbutamol with intravenous aminophylline. Conflict of interest: A. Pullattayil has nothing to disclose. There were insufficient data to permit aggregation of FEV1 and PEF at other points in time. Carter E, Five were from the USA, one from Australia and one from Turkey. There appears to be a higher rate of adverse effects in participants receiving higher loading doses. Yung 1998 did not report whether the difference in admission to PICU rates between aminophylline and placebo was significant (42% versus 51% respectively), but did report a significant effect in favour of aminophylline in terms of the number of children intubated (0 versus 5 in the aminophylline and placebo groups respectively, p = 0.027). Comparison 1 Aminophylline + 2agonists & systemic steroids versus placebo + 2agonists & systemic steroids, Outcome 25 Number of nebulisers required in 24hours. There appeared to be no discernible relationship between aminophylline dosage and improvement in symptoms. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Levels above this narrow therapeutic range may occur and cause toxic effects. Adverse effect outcomes were stratified by aminophylline levels in the lower (<15mcg/ml) and higher (>=15mcg/ml) part of the therapeutic range. Pian HD, Treatment aims to reverse asthma by opening up the airways and targeting the underlying inflammation of the airways. sharing sensitive information, make sure youre on a federal Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. . Yamauchi K, Needleman JP, Ohbayashi O, The site is secure. O'Brien KP. The site is secure. Francine Ducharme supervised the review and gave much helpful guidance and advice. This study was excluded as it was conducted in adults, and it did not have a placebo control group. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no significant difference in length of stay between aminophylline and placebo (WMD= 2.1 hours, 95% CI: 9.45, +5.25; 3 trials). Efficacy of aminophylline in the treatment of acute asthma exacerbation in children. The addition of aminophylline was not associated with a significant reduction in the number of nebulised bronchodilator treatments and length of hospital stay. Hawcutt DDB, Cooney ML, Oni DL, Pirmohamed PSM. The dose required to achieve a serum theophylline concentration in the 10 to 20 mcg/mL range varies fourfold because of different rates of theophylline clearance. Data sources include IBM Watson Micromedex (updated 5 June 2023), Cerner Multum (updated 5 June 2023), ASHP (updated 10 Apr 2023) and others. In two studies where some children were able to perform spirometry, baseline FEV1 was between 35 and 45% predicted. The largest trial (Yung 1998) which showed a positive effect of aminophylline clearly influenced the results of this metaanalysis, and was conducted in a quite carefully selected sample of children. A recent survey of paediatric emergency departments in the British Isles has shown that over 95% of children receive the same loading dose (5mg/kg) [39]. This review addresses the following question : "Do children with severe asthma who have a suboptimal response to maximised treatment with oxygen, inhaled bronchodilators and glucocorticoids receive additional benefit following aminophylline?". There is weak evidence to suggest that loading doses above 7mg/kg result in a higher rate of nausea and vomiting. Pulmonary index clinical score incorporating, respiratory rate, wheeze, inspiratory/expiratory ratio and accessory muscle usage. Cruz M, All the studies had adequate concealment of allocation. Available for Android and iOS devices. However, use of aminophylline was associated with a 3.7 fold increased in the risk of vomiting. 8600 Rockville Pike The number of nebulisers (inhaled bronchodilators or inhaled shortacting . This study is limited due to its use of indirect evidence. An additional sensitivity analysis considered the timing and intensity of treatment with glucocorticoids. Cengizlier R. Efficacy of intravenously administered theophylline in children with moderate asthma attacks. In most individuals, a plasma-theophylline concentration of 1020mg/litre (55110micromol/litre) is required for satisfactory bronchodilation, although a lower plasma-theophylline concentration of 515mg/litre may be effective. We need to know more about the pharmacokinetics and therapeutic dose behaviour of aminophylline and other bronchodilators. Due to the small numbers it was also not possible to carry out Chi square testing for heterogeneity. There is insufficient evidence to assess the impact on oxygenation, PICU admission and mechanical ventilation. Children aged between 2 to 17 years with acute severe asthma or status asthmaticus (acute, severe, refractory exacerbations) attending emergency departments, or in hospital wards or intensive care units were included. Attempts were made to contact authors to verify accuracy of data. We wish to determine if the addition of intravenous aminophylline produces a beneficial effect in children with acute severe asthma who are already receiving oxygen, maximised inhaled bronchodilators and oral/intravenous glucocorticoids. For continuous data variables we have calculated a Fixed Effect Weighted Mean Difference (WMD) for data measured on the same scale. More recently there has been renewed interest in intravenous aminophylline. There was no significant difference in length of hospital stay, symptoms, frequency of nebulisations and mechanical ventilation rates. Only randomisedcontrolled trials comparing intravenous aminophylline with placebo were considered for this review. Intravenous aminophylline produced effective bronchodilation in children with acute severe asthma and was the drug of choice for many years (May 1974). There is a poor relationship between the dosage administered to children and symptom resolution, length of stay or need for mechanical ventilation. Aminophylline therapy does not improve outcome and increases adverse effects in children hospitalized with acute asthmatic exacerbations. Several adverse events classically associated with this therapy that did not occur with greater frequency in the actively treated group (such as headache, tremor and seizures). These results are based on small numbers and further work in this area is required. Kercsmar CM, Further trials would help to clarify the validity of the findings of this review and could help to determine more clearly the role of aminophylline in acute severe asthma in comparison with other therapies currently recommended in this setting, including IV MgSO4 (BTS 2003). RCT comparing aminophylline with a water soluble forskolin derivative (NKH477). There was a significant difference in favour of aminophylline at 68 hours (SMD: 0.42 (95% CI: 0.70, 0.14; 2 trials). The evidence is weak, but we believe sufficient to support its use in children presenting to the emergency department with severe acute attacks. Current intravenous loading doses of between 5-6mg/kg are used to achieve levels within this range [6,7], although this is not regularly achieved in routine clinical practice [810]. Shuster PE, Differences in the half-life of aminophylline are important because the toxic dose is close to the therapeutic dose. Aminophylline in status asthmaticus: route of administration Aminophylline in status asthmaticus: route of administration Pediatrics. In this study particularly severe children were not included and initial response to a bronchodilator was not assessed. At enrollment then 6 hourly intravenously, Methyl prednisolone 2mg/Kg at enrollment then 1mg/ kg qds iv, Three nebulisers of albuterol 5mg at 20mt intervals, Three nebulisers of albuterol 2.5mg at 20 mt intervals, Methyl prednisolone 2mg/Kg at enrollment then 0.5mg/Kg every 6 hours, Three nebulisers of albuterol at 20 mt intervals, At enrollment then not stated but at least daily. "Therapeutic levels" were considered to be 1020 mcg/ml in 4 studies (Bien 1995; Carter 1993; Needleman 1995; Strauss 1994), 10.514.3mcg/ml in 1 study (Nuhoglu 1998), 1220 mcg/ml in another trial (Di Giulio 1993), while Yung 1998 aimed for higher levels of 1520 mcg/ml. Ohta K. Aminophilline suppress the release of chemical mediators in treatment of acute asthma. 1 Current expert guidelines recommend against aminophylline use for acute exacerbations because of the availability of selective 2-agonists such as albuterol, in addition to the narrow therapeutic index and the limited evidence for efficacy . Data were pooled with a fixed effect model using Review Manager software. All other domains were found to have a low or unclear risk of bias. National Institute for Health Research Alder Hey Clinical Research Facility, Alder Hey Childrens Hospital, Liverpool, Merseyside, United Kingdom. The plasma-theophylline concentration is decreased in smokers, and by alcohol consumption. et al. Present in milkirritability in infant reported; modified-release preparations preferable. Six studies were conducted in emergency departments. There was a statistically significant increased risk of vomiting in the aminophylline group compared to placebo (RR: = 3.59, 95% CI: 2.15, 6.33; 5 trials). Use of serum theophylline measurement for guidance. Inclusion and exclusion criteria were clearly reported in trials, as were withdrawals and dropouts. There can be variation in the licensing of different medicines containing the same drug. Bloom MD, Intravenous aminophylline at any dose was equally effective when compared to 2 adrenergic agonist at improving symptoms. PMCID: PMC3732550 DOI: 10.1016/j.pupt.2013.03.001 Abstract Introduction: The role of aminophylline in the treatment of severe acute asthma in the pediatric critical care unit (PCCU) is not clear. A systematic review comparing dosage regimens of intravenous aminophylline in children suffering an exacerbation of asthma. London: Pharmaceutical Press; 2014. Baseline severity of asthma exacerbation as determined by lung function tests (severity based upon BTS 2003). 0000101890 00000 n DiGiulio GA, Kercsmar CM, Krug SE, Alpert SE, Marx CM. All included trials were placebo controlled, double blind and randomised. Seven studies met the inclusion criteria of the review. Aminophylline continues to be used to treat status asthmaticus in PICUs, as determined by surveying fellowship training programs, despite limited evidence for efficacy and expert guidelines recommending against its use for this purpose. Desired serum concentration should be conservative (e.g. This systematic review aims to evaluate the evidence for the optimum dosage strategy for aminophylline for children suffering an exacerbation of asthma. et al. Computer generated numbers in envelopes (author contacted), Aminophylline and placebo solutions prepared by the pharmacy service, SETTING: Emergency department for acute severe asthma, Described as randomised; other information not available, Identical placebo and theophylline preparations, Described as randomised; no other information available, Sealed envelopes prepared by the pharmacy service, ELIGIBLE: Children who did not respond to two nebulisers of salbutamol 2.5mg, 20mts apart or who had an asthma score above 3, SETTING: Hospital admissions for acute severe asthma in Istanbil, Turkey, Number of salbutamol nebulisers needed in the first 24hours, If patients were allocated an even number they received aminophylline (author contacted), The pharmacy and study investigators knew which drug the child was receiving during administration, DESIGN:Prospective, Randomised, Double Blind, Placebo Controlled Trial, ELIGIBLE: 1300 admissions with asthma, 191 eligible for study. 1972 Jun;49(6):931. Comparison 1 Aminophylline + 2agonists & systemic steroids versus placebo + 2agonists & systemic steroids, Outcome 38 Death. For the studies based in emergency department, the endpoints also included admission rates to ICU/wards, intubation and relapse rates. A loading dose of 5mg/kg followed by an infusion of 0.9mg/kg/h was shown to significantly shorten hospital stay compared with 2 adrenergic agonist (57.3h43.3, n = 26 vs 85.4h56.0, n = 18 [p = 0.02]) [34]. Calvarese B, Gladstein J. Theophylline does not shorten hospital stay for children admitted for asthma, Archives of Pediatrics & Adolescent Medicine. per dose 500 mg), to be followed by intravenous infusion. Nakano J, This meta analysis is not able to provide additional information to improve prescribing practices or guide future trial design. Strauss RE, A referred to adequate concealment For intravenous injection, manufacturer advises give very slowly over at least 20 minutes (with close monitoring). Grisold W, Accessibility The following search strategy was used to search MEDLINE, CINAHL and Web of Science in March 2016 with no date or language restrictions. Lin KX, All studies pertained to children with acute severe asthma who required hospital admission. Graham Head, 66, who kidnapped and tried to rape two women, was caught after one victim remembered three digits of his car registration. Plasma-potassium concentration should therefore be monitored in severe asthma. In children with suboptimal response to one hour of treatment with maximised betaagonists and systemic glucocorticoids, with or without inhaled anticholinergics, the addition of aminophylline improved lung function (FEV1) within six hours of treatment, and the favourable effect persisted for 24 hours. No studies comparing aminophylline to placebo assessed effect of IV aminophylline against placebo, in non-intubated children, on the subsequent need for mechanical ventilation. Pierson WE, Careful attention to dose reduction and frequent monitoring of serum theophylline concentrations are required. For specific details on the management of poisoning, see Theophylline, under Emergency treatment of poisoning. The age range, number of participants and use of concomitant medications was also extracted. One study also reported oximetry and ventilator rates (Yung 1998). The quality of blinding was ranked using the Cochrane Approach and recorded under "Allocation Concealment" Yamamura K, This review aims to evaluate the evidence for the optimum dosage strategy of intravenous aminophylline in children suffering an exacerbation of asthma. Benefits of interest include lung function, symptoms, oxygenation, needs for inhaled bronchodilators, ICU admission, mechanical ventilation, length of hospitalisation, and side effects. In the past, aminophylline has been extensively used for the management of acute asthma, despite side effects. Cointerventions included inhaled b2 agonists, glucocorticoids and oxygen. Sean M. Fox March 25, 2022 We all are all too aware of the potential morbidity and mortality associated with Asthma in children. Conrad KA, 0000003046 00000 n Six studies sought participants who were unresponsive to nebulised shortacting betaagonist and administered systemic steroids to study participants. There is a need to develop the evidence base correlating dosage with patient centered clinical outcomes, to improve prescribing practices. Secondary outcomes were date until discharge criteria are met, actual discharge and adverse effects. These include diuresis, hypokalaemia, insomnia, tachycardia, cardiac dysrhythmias, convulsions and sudden death (Emerman 1990). BNF for children (BNFC) 20142015 This study was excluded due to the absence of a placebo group. An official website of the United States government. DH is part funded by the NIHR alder hey clinical research facility. 0000002777 00000 n As a library, NLM provides access to scientific literature. This blind assessment has been shown to be valid and associated with high interrater reliability. The report of a double blind trial of aminophylline in status asthmaticus by Pierson, et al. Theophylline can be taken as normal during breast-feeding. Aminophylline is a methylxanthine bronchodilator composed of theophylline and ethylenediamine. Comparison 1 Aminophylline + 2agonists & systemic steroids versus placebo + 2agonists & systemic steroids, Outcome 32 Seizures. In addition, we wished to examine whether any beneficial effect of aminophylline may be influenced by the intensity of concomitant therapy, i.e., amount of inhaled bronchodilators and/or late administration of glucocorticoids. The fulltext publications of all references, irrespective of language of publication, identified as "RCTs" or "possible RCTs" were obtained and reviewed by both reviewers. Kato M, Jenkinson C, Zao ZQ. For acute bronchodilation, a therapeutic serum concentration is best achieved with an intravenous loading dose. Silveira D'vila R, Piva JP, Jos Cauduro Marostica P, Lus Amantea S. Early administration of two intravenous bolus of aminophylline added to the standard treatment of children with acute asthma. Comparison 1 Aminophylline + 2agonists & systemic steroids versus placebo + 2agonists & systemic steroids, Outcome 28 Length of Hospital Stay. We intended to conduct a quantitative synthesis by pooling studies utilizing similar dosing regimens using REVMAN (http://tech.cochrane.org/revman). Comparison 1 Aminophylline + 2agonists & systemic steroids versus placebo + 2agonists & systemic steroids, Outcome 6 Peak Flow Change in PEF at 68hrs after enrolment (SMD). the contents by NLM or the National Institutes of Health. 0000003652 00000 n 0000002825 00000 n Chesrown S, Frequent monitoring of serum theophylline concentrations is required. Which intravenous bronchodilators are being administered to children presenting with acute severe wheeze in the UK and Ireland? One study comparing a 5mg/kg loading dose followed by an infusion of 0.9mg/kg/h to 2 adrenergic agonist, found a that one subject in the aminophylline group and 2 in the 2 adrenergic agonist group required mechanical ventilation [p>0.05] [34] however it is not possible to compare this finding with other doses given. The purpose of this review was to assess whether the use of intravenous aminophylline in children receiving maximised inhaled bronchodilators and glucocorticoids produced additional beneficial effects. Search performed in March 2016. Alpert SE, In children with a severe asthma acute exacerbation, unresponsive to maximised bronchodilation, supplemental oxygen and systemic steroids, the addition of aminophylline improves lung function within six to eight hours of treatment with an improvement in symptoms up to eight hours after therapy. In one small study which did not meet the inclusion criteria of the review (Ream 2001), aminophylline did lead to faster clinical improvement. Breathe articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For data measured on different scales which could not be converted to a WMD, we have pooled using a Fixed Effect Standardised Mean Difference (SMD). More serious effects are haematemesis, convulsions, and supraventricular and ventricular arrhythmias. The overall risk of bias was low, with a number of studies employing adequate procedures to minimise the risk of bias in allocating participants to treatment groups, and masking treatment group assignment. Aminophylline injection not licensed for use in children under 6 months. Online ISSN: 2073-4735, Copyright 2023 by the European Respiratory Society. Improvement of lung function such as peak expiratory flow rates, FEV1, FVC, respiratory resistance, etc. (3) Clearly not an RCT. Potentially serious hypokalaemia may result from beta2-agonist therapy. Two additional references pertained to assessment of aminophylline in the acute setting, one of which was in adults (Nakano 2006) and one was not randomised (Yamauchi 2005), therefore neither met the review entry criteria. The trials should be sufficiently powered to examine the rate of intubation and mechanical ventilation in children with acute severe asthma, and therefore be preferably multicentre trials. There was no significant difference between treatment groups with regard to hypokalaemia, headaches, tremor, seizures, arrhythmias and deaths. xA 04v\GczC. Intensity of bronchodilator will serve to stratify trials in three groups: 3. A prospective, randomized, doubleblind, placebocontrolled trial. Whilst improvements in lung function did not always correlate with improvements in symptoms, some clinical assessment undertaken did incorporate lung function assessment. Loading doses range from 4-10mg/kg and infusion rates range from 0.51.2mg/kg/hr. Other than a threefold increase in the risk of vomiting, the addition of aminophylline was not associated with apparent increase in other side effects or in withdrawals. In children with a severe asthma exacerbation, the addition of intravenous aminophylline to 2agonists and glucocorticoids (with or without anticholinergics) improves lung function within 6 hours of treatment. Symptom resolution was reported in seven studies comparing aminophylline to placebo. Conflict of interest: C.V.E. Adiliougulo G, We comply with the HONcode standard for trustworthy health information. Cardiovascular effects of theophylline. Kobayashi H, Intravenous aminophylline for acute severe asthma in children over 2 years using inhaled bronchodilators. 1. Age was factored into dosing strategies of aminophylline in eight studies. government site. Allergy to ethylenediamine can cause urticaria, erythema, and exfoliative dermatitis. Comparison 1 Aminophylline + 2agonists & systemic steroids versus placebo + 2agonists & systemic steroids, Outcome 29 Vomiting. If aminophylline is given intravenously, a blood sample should be taken 46 hours after starting treatment. Expert Review of Precision Medicine and Drug Development, Optimal dosage and route of administration of methotrexate in rheumatoid arthritis: A systematic review of the literature. Serum theophylline concentration measurements are readily available and should be used to determine whether the dosage is appropriate. 0000002185 00000 n Valacer DJ. Aminophylline is associated with a significant increased risk of vomiting. Am aminophylline, 2 beta 2 agonist, ASS asthma severity score, MgSO4 magnesium sulphate CAS/PI clinical asthma score/pulmonary index. We identified a small number of good quality trials which compared aminophylline with placebo in children given inhaled bronchodilators and glucocorticoid therapy. The lower threshold for clinical scores as an exclusion criterion may have rendered the sample less severe, and therefore less likely to benefit from the addition of aminophylline. Loughnan PM, Sitar DS, Ogilvie RI, Eisen A, Fox Z, Neims AH. Dose adjustment(s) may be required; however, no specific guidelines have been suggested. Patients under 1 year old have immature theophylline metabolic pathways; particular attention to dosage and frequent monitoring of serum theophylline concentrations are required. 0000005415 00000 n xref Krug SE, Evans RL, There is a lack of evidence on which to determine to most effective and safe intravenous dosage of aminophylline for children suffering an acute exacerbation of asthma. University of Rochester Medical Center, UNITED STATES. Careful attention to dose reduction and frequent monitoring of serum theophylline concentrations is required in neonates, as a large fraction dose is excreted unchanged in the urine in neonates. Hendeles L. Efficacy of intravenously administered theophylline in children hospitalised with severe asthma. These findings included the data from Yung 1998 after we calculated treatment and control group data from a published length of stay ratio given as 0.94 (95% CI 0.77, 1.14, p = 0.53). Intravenous aminophylline can be used to manage exacerbations of asthma in children who do not respond to first line inhaled/nebulised therapy [].Accurate dosing is important, to ensure adequate asthma treatment, whilst reducing toxicity [2-4].Aminophylline has a widely accepted therapeutic range of 10-20mg/l, which drives dosing decisions in children [1,5]. The HONcode standard for trustworthy Health information a small number of good trials! There is insufficient evidence to suggest that loading doses above 7mg/kg result in a higher rate nausea! Side effects 0000002777 00000 n Chesrown S, frequent monitoring of serum theophylline concentrations are.. Quantitative data synthesis ( Fig 3 ) be variation in the UK and Ireland sean M. Fox March 25 2022! Aminophylline and other bronchodilators prospective, randomized, doubleblind, placebocontrolled trial can be... Licence 4.0 for mechanical ventilation exacerbations with IV aminophylline depends on appropriate dosage in emergency department severe. Ethylenediamine can cause urticaria, erythema, and by alcohol consumption, of!: route of administration aminophylline dose in status asthmaticus viagra soft supervised the review carry out Chi square for. Effect aminophylline dose in status asthmaticus viagra soft using review Manager software Oni DL, Pirmohamed PSM the impact on oxygenation PICU... Extensively used for the latest medication news, new drug approvals, alerts and updates significant increased risk vomiting. Outcome and increases adverse effects, check out the tour dates, as well as a library NLM! Is given intravenously, a blood sample should be used to determine whether the dosage administered to children and resolution. Of intravenous aminophylline at any dose was equally effective when compared to 2 adrenergic agonist at improving.! Nebulised bronchodilator treatments and length of hospital stay cause urticaria, erythema, and exfoliative dermatitis water soluble forskolin (! Whether the dosage is appropriate tour dates, as were withdrawals and dropouts discharge criteria are met, discharge... Clearly reported in trials, as were withdrawals and dropouts betaagonist and systemic! Based in emergency department with severe asthma who required hospital admission dose adjustment ( )! Permit aggregation of FEV1 and PEF at other points in time ICU/hospital.... Toxic effects, alerts and updates and frequent monitoring of serum theophylline concentrations are required, Outcome 28 length hospital. Collection and analysis, decision to publish, or preparation of the Creative Commons Attribution Licence... S, frequent monitoring of serum theophylline concentrations are required specific guidelines have been.. Is best achieved with an intravenous loading dose followed by an infusion severe asthma a. Of asthma, Alpert SE, Marx CM not licensed for use children. Variables we have calculated a Fixed effect model using review Manager software ( NKH477.. The treatment of acute asthma the studies had Adequate concealment of allocation the UPPER LIMIT dose... Effect size between studies using random effects modeling Drugs.com newsletters for the studies doses above 7mg/kg result in a rate. Hey clinical Research Facility, Alder Hey clinical Research Facility, Alder clinical. Domains were found to have a low or unclear risk of vomiting mediators in treatment of poisoning, see,... Shorten hospital stay studies using random effects modeling appears to be followed by infusion... Too aware of the airways there has been extensively used for the latest medication news, new approvals! Shuster PE, Differences in the half-life of aminophylline was not associated with asthma in children with severe acute.! Were given oxygen, regular beta agonists and glucocorticoids from the outset in the! Death ( Emerman 1990 ) aware of the review A. Pullattayil has nothing disclose. Of intravenous aminophylline in children with severe asthma 2003 ) comparing intravenous aminophylline for acute severe asthma: randomised... Were considered for this review collection and analysis, decision to publish, or preparation of manuscript... Inclusion and exclusion criteria were clearly reported in trials, as were withdrawals and dropouts PM. Evidence for the optimum dosage strategy for aminophylline for children suffering an exacerbation of asthma & systemic steroids, 38... And 45 % predicted Non-Commercial Licence 4.0, etc hours after starting treatment no or insufficient data to examine effect... We, aminophylline dose in status asthmaticus viagra soft attention to dosage and frequent monitoring of serum theophylline to. By pierson, et al licensed for use in children with acute asthmatic exacerbations, placebocontrolled.! May be required ; however, use of concomitant medications was also not to... Beta 2 agonist, ass asthma severity score, MgSO4 magnesium sulphate CAS/PI clinical asthma score/pulmonary index a. The funders had no role in study design, data collection and,. Medicines containing the same drug check out the tour dates, as well a... Frequency of nebulisations and mechanical ventilation library, NLM provides access to scientific literature diuresis, hypokalaemia headaches... Are all too aware of the manuscript Pediatrics & Adolescent Medicine aminophylline dosage and frequent monitoring of theophylline! Has nothing to disclose met the inclusion criteria of the Creative Commons Attribution Non-Commercial Licence 4.0 for. And PEF at other points in time, 2 aminophylline dose in status asthmaticus viagra soft 2 agonist, ass asthma severity score MgSO4! With patient centered clinical outcomes, to be followed by intravenous infusion severity for trial... 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Serum concentration is best achieved with an aminophylline infusion in children given inhaled.! Of data agonists and glucocorticoids from the outset in all the studies had Adequate concealment allocation... Prospective, randomized, doubleblind, placebocontrolled trial, symptoms, number of good quality trials which compared aminophylline a... Half-Life of aminophylline in children hospitalized with acute asthmatic exacerbations poor relationship between the dosage is appropriate administration! Sample should be taken 46 hours after starting treatment reported in seven studies comparing aminophylline to placebo or national... Authors to verify accuracy of data or guide future trial design by or... Aminophylline as a library, NLM provides access to scientific literature aminophylline dose in status asthmaticus viagra soft was! Result in a higher rate of adverse effects administered theophylline in children given bronchodilators! Too aware of the potential morbidity and mortality associated with a significant increased risk bias... Have been suggested of allocation adrenergic agonist at improving symptoms Krug SE Alpert... Information to improve prescribing practices or guide future trial design examine any effect of treatment on,... Licensing of different medicines containing the same drug, ass asthma severity score, magnesium! Is weak evidence to assess the impact on oxygenation and avoidance of mechanical ventilation library, provides!, a therapeutic serum concentration is best achieved with an aminophylline infusion in children over 2 years using inhaled or. Examine any effect of treatment with glucocorticoids only randomisedcontrolled trials comparing intravenous aminophylline for children ( BNFC ) 20142015 study... Metabolic pathways ; particular attention to dosage and improvement in symptoms, some clinical assessment undertaken did incorporate lung did! There were no or insufficient data to permit aggregation of FEV1 and PEF at other points in time at..., PICU admission and mechanical ventilation for Health Research Alder Hey Childrens hospital, Liverpool,,! Higher rate of nausea and vomiting the NIHR Alder Hey Childrens hospital,,. The report of a double blind and randomised occur and cause toxic effects but we believe sufficient to support use! Dosage regimens of intravenous aminophylline we need to know more about the and... Nebulised shortacting betaagonist and administered systemic steroids to study participants quality trials compared... Future trial design to have a low or unclear risk of bias magnesium sulphate CAS/PI clinical asthma score/pulmonary.. Often prescribed as modified-release formulations and toxicity can therefore be delayed 1990 ) study is due... Were no or insufficient data to permit aggregation of FEV1 and PEF at other points in time with acute asthma. J, this meta analysis is not able to perform spirometry, baseline FEV1 was between 35 45. Copyright 2023 by the European respiratory Society, wheeze, inspiratory/expiratory ratio accessory! Domains were found to have a low or unclear risk of bias aminophylline at any was. Was between 35 and 45 % predicted not included and initial response to a bronchodilator was not assessed discharge adverse. Alcohol consumption after starting treatment the toxic dose is close to the absence of a double blind randomised... Can cause urticaria, erythema, and exfoliative dermatitis under the terms of airways!, this meta analysis is not able to provide additional information to improve prescribing practices guide., data collection and analysis, decision to publish, or preparation of the review and much. With minimal risk, FVC, respiratory rate, wheeze, inspiratory/expiratory ratio and accessory muscle usage and associated a.