LONDON—Intravenous (IV) aminophylline is rarely used to manage severe acute asthma in this country; however, it has been widely used in Britain. A recent randomized study that compared infused IV aminophylline with a short bolus of albuterol found that patients given albuterol stayed in the hospital almost 50% longer than did aminophylline recipients.[1] However, closer examination of the data suggests that the real difference may lie not in the drugs, but in the administration method.

Within the first few hours, acknowledged author Graham Roberts, BM, MSc, “a bolus of albuterol is as effective in treating severe asthma in childhood as an aminophylline infusion.” But, he noted, children on aminophylline infusions had shorter hospital stays.

“In the UK, the standard treatment had been an aminophylline infusion,” noted Dr. Roberts, a clinical research fellow in Paediatric Respiratory and Allergy Medicine at the Imperial College School of Medicine in London. Yet because of aminophylline’s reported side effects (abdominal pain, nausea, and vomiting) and the additional monitoring required for sustained administration, IV albuterol given as a brief bolus began to replace aminophylline for severe acute asthma. However, direct comparisons between the treatment regimens were few.

Forty-four patients ages 1 to 16 who presented with severe acute asthma unresponsive to nebulized agents were enrolled in the study; 18 received an albuterol bolus (15 mg/kg over 20 min), and 26 received a continuous infusion of aminophylline (bolus of 5 µg/kg over 20 min, followed by infusion of 0.9 mg/kg/h). Asthma severity scores were recorded just before IV therapy and one, two, six, 12, and 24 hours later.

No differences in asthma severity scores or in adverse effects were detected between the groups within the first 24 hours. However, in the albuterol group, there was a nonsignificant trend toward a longer need for supplemental oxygen. Importantly, patients who received aminophylline infusions remained in the hospital for an average of 57.3 hours, as compared with a mean time to discharge of 85.4 hours for patients who received an albuterol bolus—a 49% difference in the length of hospital stay.

“Aminophylline infusion is superior to a bolus of albuterol for treating severe acute asthma in childhood,” Dr. Roberts stated. “Therefore, we shouldn’t be using just a short bolus of albuterol to treat severe acute asthma.” But, he noted, “we’re comparing a bolus of albuterol with aminophylline infusion.” Continuous infusion could be responsible for aminophylline’s advantage.

Continuous infusion may be required to give the full benefit of an IV medication, Dr. Roberts suggested. “What we don’t know is whether albuterol or aminophylline infusion is the sensible way to go.”

—Mimi Zucker, PhD