Hospital treatment of asthma: lack of benefit from theophylline given in addition to nebulized albuterol and intravenously administered corticosteroid.
OBJECTIVE
To determine the efficacy of theophylline when given in addition to nebulized albuterol and intravenously administered corticosteroid to children hospitalized with mild to moderate asthma.


METHODS
Randomized, prospective, placebo-controlled, double-blind trial.


METHODS
Tertiary-care children's hospital.


METHODS
Twenty-nine patients with asthma between the ages of 2 and 16 years completed the study. The treatment and placebo groups were similar in age, gender, race, illness severity, and emergency department treatment.


METHODS
All patients received intravenously administered methylprednisolone and nebulized albuterol. The treatment group received intravenous theophylline therapy and the placebo group dextrose in water. When intravenously administered medications were discontinued, therapy continued with oral administration of theophylline (or placebo) and of prednisone.


RESULTS
Twice-daily assessments of clinical asthma symptoms were made by using a scoring system consisting of respiratory rate, inspiratory/expiratory ratio, wheeze, and accessory muscle use. Time required to reach study discharge criteria (asthma score < or = 2) (30.4 +/- 16.8 vs 27.0 +/- 10.3 hours; p = 0.51) and the rate of improvement of the clinical asthma score (-0.10 +/- 0.05 unit/hr vs -0.11 +/- 0.09 unit/hr; p = 0.88) were not significantly different between the theophylline and placebo groups. The number of albuterol aerosol treatments required and the adverse effects experienced were not significantly different between groups.


CONCLUSIONS
When the combination of systemically administered corticosteroid and inhaled albuterol is used in the treatment of children hospitalized with mild to moderate asthma, addition of theophylline may not be justified.
DiGiulio
G A
GA
Department of Pediatrics, Case Western Reserve University, Rainbow Babies and Childrens Hospital, Cleveland, Ohio.
Kercsmar
C M
CM
Krug
S E
SE
Alpert
S E
SE
Marx
C M
CM
D000280:Administration, Inhalation; D000293:Adolescent; D000420:Albuterol / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006760:Hospitalization; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay; D008775:Methylprednisolone / Q000008:administration & dosage*; D010092:Oximetry; D011446:Prospective Studies; D013806:Theophylline / Q000008:administration & dosage*; D016896:Treatment Outcome
D013806:Theophylline; D000420:Albuterol; D008775:Methylprednisolone