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).
Between March 2001 and February 2002, 60 children (2-5 years old), admitted to the
PER at Hospital de Clínicas 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 6h later. The intervention
group received aminophylline 5mg/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.
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.
In children aged 2-5 years admitted to a PER with asthma, two intravenous doses of
5mg/kg of aminophylline given 6h 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.