Early administration of two intravenous bolus of aminophylline added to the standard treatment of children with acute asthma

Objectives: Evaluate the efficacy of adding two intravenous bolus of aminophylline to the standard treatment of acute asthma episode in children admitted to the pediatric emergency room (PER). Methods: Between March 2001 and February 2002, 60 children (2-5 years old), admitted to the PER at Hospital de Clinicas de Porto Alegre (Brazil), due to an episode of acute asthma, refractory to conventional therapy (an oral dose of steroids and at least three doses of inhaled albuterol, associated or not with oxygen) were enrolled in a randomized, double blind, placebo controlled clinical trial. The randomization was performed in blocks of 10 patients, who received a "bronchodilator solution" (either saline or aminophylline), in two doses: on arrival at the PER and again 6 h later. The intervention group received aminophylline 5 mg/kg/dose diluted in normal saline (NS) solution up to a 20 mL volume, while the placebo group received plain NS, both in an infusion rate of 1 cc/min. The main outcomes were total length of hospital stay, length of supplemental oxygen use, number of bronchodilator nebulizations and/or aerosol inhalations performed and patient destination. The groups were compared using the Students t-test, Mann-Whitney test and Chi-Square test, accepting p<0.05 as significant. Results: Comparing the main outcomes, we did not find differences between the placebo and aminophylline groups: 29.0 +/- 14.7 versus 26.2 +/- 13.4 beta-agonist nebulizations per patient (p = 0.46); 2.4 +/- 10.6 versus 5.6 +/- 14.2 aerosol inhalations per patient (p = 0.32); 24.7 +/- 30.0 versus 26.0 +/- 25.2h for oxygen supplement (p=0.86); 43.2 +/- 30.0 versus 43.6 +/- 23.7h for length of hospital stay (p=0.95). We also did not find differences between the two groups related to the blood pressure, heart rate, respiratory rate and oxygen saturation. Conclusion: In children aged 2-5 years admitted to a PER with asthma, two intravenous doses of 5 mg/kg of aminophylline given 6 h apart did not change the length of stay in hospital, the number of nebulizations given or the duration of oxygen therapy required. We are unable to tell whether there would be benefit with higher doses of aminophylline designed to give levels in the usual therapeutic range. (C) 2007 Elsevier Ltd. All rights reserved.