Intravenous
aminophylline is effective in children with acute
asthma and was the
bronchodilator of choice for many years. However, with the advent of inhaled b agonists and
anticholinergic agents an alternative, less invasive, therapeutic strategy is currently available. If children with acute
asthma fail to respond to inhaled
therapy clinicians may consider
aminophylline a controversial treatment. The published evidence on whether
aminophylline produces further beneficial effect in children already receiving inhaled
therapy for acute
asthma is reviewed in this paper. The published randomised controlled trials comparing
aminophylline with placebo are of good methodological quality, although the numbers of children in many of the studies are small. Trial outcomes included lung function (FEV1 and PEF) and clinical scoring of
asthma severity.
Aminophylline improved percentage predicted FEV1 by 6 hours, and this effect was maintained for 24 hours. Improvements were also seen in clinical
asthma severity scores at 6 hours. Despite improvements in lung function and
asthma severity, there was no reduction in
hospital stay or the number of nebulisers required. The main side effect of
aminophylline therapy was an increased incidence of
vomiting. In conclusion, the addition of intravenous
aminophylline should be considered early in the treatment of children hospitalised with acute severe
asthma with suboptimal response to the initial inhaled
bronchodilator therapy. Further research should be carried out to examine whether intravenous
aminophylline may have a beneficial effect in other settings such as
intensive care to determine if it may reduce intubation and ventilation rates.