The effects of intravenous aminophylline when added to bronchodilator drugs for acute asthma

Parameswaran K, Belda J, Rowe BH

Published Online:

January 21, 2009

In an asthma attack, the airways (passages to the lungs) narrow from muscle spasms and swelling (inflammation), which can cause breathing problems, wheezing and coughing. Attacks can be fatal. The main drugs used to relieve a major asthma attack are bronchodilators (reliever inhalers to open up the lungs and airways) for the spasms, and corticosteroids for the swelling. The drug aminophylline has also been used intravenously (through the veins). However, the review of trials found that aminophylline is no better than other bronchodilator drugs, and has more adverse effects.

Abstract (click to read)

Background:

Aminophylline has been used extensively in acute asthma, but its role is unclear especially with respect to any additional benefit when added to beta2-agonists.

Objectives:

To determine the magnitude of effect of the addition of intravenous aminophylline to beta2-agonists in adult patients with acute asthma treated in the emergency setting.

Search strategy:

Studies were identified from the following sources: The Cochrane Airways Group register (derived from MEDLINE, EMBASE, CINAHL standardised searches), hand searched respiratory journals and meeting abstracts. Potentially relevant articles were obtained, and their bibliographic lists were hand searched for additional articles. The search included searches of the database up to 1999.

Selection criteria:

Randomised controlled trials comparing intravenous aminophylline versus placebo in adults with acute asthma and treated with beta-adrenergic agonists. Patients could be treated with or without corticosteroids or other bronchodilators.

Data collection and analysis:

A total of 210 abstracts were identified. Two independent reviewers selected a total of 27 eligible studies for possible inclusion, in which quality assessment was performed and a third reviewer was used to adjudicate disagreements. Peak expiratory flow (PEFR) and forced expiratory volume in the first second (FEV1) data were extracted and entered in Review Manager from these studies. Information not obtained from the authors was estimated from graphs. All data were entered and double checked by two reviewers. Results are reported as weighted mean differences (WMD) or odds ratio (OR), both with 95% confidential intervals (CI).

Main results:

Fifteen studies were included. Overall, the quality of the studies was only moderate; concealment of allocation was assessed as clearly adequate in only seven (45%) of the trials. The doses of aminophylline and other medications and the severity of asthma varied between studies.

There was no statistically significant effect of aminophylline on airflow outcomes at any time period. The aminophylline treated group had higher values of PEFR at 12 (PEFR 8 L/min or 2.3%) and 24 hours (PEFR 22 L/min or 6.4%), but these were not significant (p>0.05). Two subgroup analyses were performed by grouping studies according to mean baseline airflow limitation (n = 11 studies) and the use of any steroids (n = 9 studies). There was no relationship between baseline airflow limitation nor the use of steroids on the effect of aminophylline. Aminophylline treated patients reported more palpitations/arrhythmias (OR: 2.9; 95% CI: 1.5 to 5.7) and vomiting (OR: 4.2; 95% CI 2.4 to 7.4), but no difference was found in tremor or hospital admissions.

Authors' conclusions:

In acute asthma, the use of intravenous aminophylline did not result in any additional bronchodilation compared to standard care with beta-agonists. The frequency of adverse effects was higher with aminophylline. No subgroups in which aminophylline might be more effective could be identified. These results should be added to consensus statements and guidelines.

This record should be cited as:

Parameswaran K, Belda J, Rowe BH. Addition of intravenous aminophylline to beta2-agonists in adults with acute asthma. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD002742. DOI: 10.1002/14651858.CD002742

Assessed as up to date:

June 19, 2000

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Airways Group

Asthma topics:

Treating with Medications > Asthma Attacks > Beta agonists

Treating with Medications > Asthma Attacks > Xanthines

Health topics:

Lungs & airways > Asthma (acute) > Bronchodilators

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

The effects of intravenous aminophylline when added to bronchodilator drugs for acute asthma

More like this

Copyright © 2012 - The Cochrane Collaboration