A clinical trial to determine whether intravenous aminophylline is indispensable in the treatment of status asthmaticus

Abstract

In Japan, intravenous aminophylline (AMP) is considered as the first treatment of choice for status asthmaticus, whereas inhaled beta 2-agonist is considered to be of no value for acute severe asthma. To determine the optimal therapy for acute asthma, the authors clinically investigated bronchodilating effects and the clinical role of aerosolized beta 2-agonist inhalation and intravenous AMP in 55 patients with status asthmaticus. Patients were classified into two groups treated without intubation and with artificial ventilation. Intravenous steroid (equivalent to 4 mg/kg of hydrocortisone) was administered in all cases. Further, all patients were randomly divided into two subgroups according to treatment regimen, i.e. repeated inhalation of aerosolized beta 2-agonists only, and combined with intravenous AMP. In all groups, the duration of treatment was significantly shorter in the subgroups treated with repeated aerosolized beta 2-agonist inhalation than those treated with intravenous AMP. The failure of intravenous AMP to effect more rapid or profound improvement both in objective and subjective parameters suggested that inhaled beta 2-agonist with intravenous steroid should be a rational choice in the initial treatment of acute asthma. Moreover, inhaled beta 2-agonist used optimally produces good bronchodilation several times greater than that produced by intravenous AMP. We concluded that repeated inhalation of aerosolized beta 2-agonists is the drug of choice combined with intravenous steroid regardless of the severity of attacks for short-term therapy of acute severe asthma, and that intravenous AMP may have only minor bronchodilating effects.