Addition of intravenous aminophylline to beta2-agonists in adults with acute asthma

Evidence Summaries

Level of Evidence = B
In acute asthma, the use of intravenous aminophylline appears not to result in better bronchodilatation than inhaled beta2-agonists alone. Aminophylline causes adverse effects.

A Cochrane review 1 included 17 studies. The quality of the studies was only moderate. There was no statistically significant effect of aminophylline on airflow outcomes at any time period. People treated with aminophylline and beta2-agonists had similar peak expiratory flow (PEF) values compared to those treated with beta2-agonists alone at 12 h (MD 8.30 L/min; 95% CI -20.69 to 37.29 L/min). 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. Aminophyllinen treated patients reported more palpitations/arrhythmias (OR 3.02, 95% CI 1.5 to 7.9) and vomiting (OR 4.2, 95% CI 2.2 to 8.07) but no difference was found in tremor or hospital admissions.

Comment: The quality of evidence is downgraded by study limitations.

References

1. Parameswaran K, Belda J, Rowe BH. Addition of intravenous aminophylline to beta2-agonists in adults with acute asthma. Cochrane Database Syst Rev 2000;(4):Nair P, Milan SJ, Rowe BH. Addition of intravenous aminophylline to inhaled beta(2)-agonists in adults with acute asthma. Cochrane Database Syst Rev 2012;12():CD002742.  [PMID:23235591] .


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