title: Aminophylline therapy for acute bronchospastic disease in the emergency room.
abstract: OBJECTIVE
  To assess the role of aminophylline in the treatment of acute exacerbations of bronchospastic disease when used in addition to inhaled beta-agonists and intravenous corticosteroids.
  
  
  METHODS
  Randomized, double-blind, placebo-controlled intervention study.
  
  
  METHODS
  One hundred thirty-three adult patients with either asthma or chronic obstructive pulmonary disease who presented to the emergency department with asthma or wheezing.
  
  
  METHODS
  All patients received therapy with both aerosolized metaproterenol and intravenous methyl-prednisolone. Patients were randomly assigned to receive either a loading dose of aminophylline followed by a routine infusion (n = 65) or an equal volume of placebo as a loading dose and infusion (n = 68).
  
  
  RESULTS
  At discharge from the emergency department, the median serum theophylline concentration for the aminophylline group was 54 mumol/L (9.7 mg/L). The two groups showed no differences (P greater than 0.2) in measurements of forced expiratory volume at 1 second (FEV1), forced vital capacity (FVC), or peak expiratory flow rate (PEFR) at baseline or at 60 or 120 minutes after aminophylline administration. Neither patient satisfaction nor physician assessment of response to therapy differed between the two groups. There was no difference (P greater than 0.2) in the frequency of side effects, except for a trend toward a higher frequency of nausea (P = 0.13) in the aminophylline group. There was, however, a threefold decrease in the hospital admission rate for patients treated with aminophylline (6%) compared with placebo recipients (21%) (P = 0.016).
  
  
  CONCLUSIONS
  Aminophylline, in doses producing levels just below the commonly accepted therapeutic range, appears to decrease hospital admissions in patients with acute exacerbation of asthma or chronic obstructive pulmonary disease. This finding, if confirmed in larger studies, may represent a substantial cost savings.
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: K
authors.initials: K
authors.lastname: Wrenn
authors.forename: C M
authors.initials: CM
authors.lastname: Slovis
authors.forename: F
authors.initials: F
authors.lastname: Murphy
authors.forename: R S
authors.initials: RS
authors.lastname: Greenberg
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000628:Aminophylline / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications; D001986:Bronchial Spasm / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004630:Emergencies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications; D008297:Male; D009921:Metaproterenol / Q000627:therapeutic use; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged
chemical_list: D000628:Aminophylline; D009921:Metaproterenol; D008775:Methylprednisolone