Intravenous aminophylline treatment for severe asthma exacerbation in a toddler: an evidence-based case report
Main Article Content
Keywords
Aminophylline, severe asthma attack, asthma exacerbation
Abstract
Introduction: Asthma is the most prevalent chronic condition in childhood causing enormous morbidity and mortality worldwide. Acute severe exacerbations are potentially life-threatening and often need hospitalization. Incomplete or poor response to initial treatment requires additional interventions that commonly are intravenous second-line drugs, of which Aminophylline is one of them. Although Aminophylline is costly and effective, views are polarising that its use is unsafe. Herein we report a case of intravenous aminophylline use in severe asthma exacerbation in a toddler.
Case description: A 3-year-old boy previously diagnosed with asthma came to the emergency room due to severe shortness of breath. He had breathlessness which was more pronounced when he was lying down. He looked restless and irritable. Bilateral wheezing, tachypnea, tachycardia and chest withdrawal were noted. Because of poor response to standard initial treatment, intravenous Aminophylline was given and showed complete relief without the occurrence of the anticipated serious adverse event.
Conclusion: When first-line inhaled/nebulized medication fails to control a child's asthma exacerbation, Aminophylline may be utilized. It must be considered a cost-effective treatment for acute asthma exacerbations, especially for developing countries with limited health budgets, even though it is thought to have a narrow therapeutic range and a large inter-individual variance in clearance.
References
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21. Mahemuti G, Zhang H, Li J, Tieliwaerdi N, Ren L. Efficacy and side effects of intravenous theophylline in acute asthma: a systematic review and meta-analysis. Drug Des Devel Ther. 2018;12:99–120. Available from: https://pubmed.ncbi.nlm.nih.gov/29391776
22. Neame M, Aragon O, Fernandes RM, Sinha I. Salbutamol or aminophylline for acute severe asthma: how to choose which one, when and why? Arch Dis Child - Educ & Pract Ed. 2015;100(4):215–22. Available from: http://dx.doi.org/10.1136/archdischild-2014-306186
23. Nakano J, Yano T, Yamamura K, Yoshihara H, Ohbayashi O, Yamashita N, et al. Aminophilline suppress the release of chemical mediators in treatment of acute asthma. Respir Med. 2006;100(3):542–50. Available from: http://dx.doi.org/10.1016/j.rmed.2005.05.023
24. Anderson M. The properties of aminophylline. Emerg Nurse. 2007;15(7):24–7. Available from: http://dx.doi.org/10.7748/en2007.11.15.7.24.c6254
25. Cooney L. Aminophylline: Developing Evidence Based Dosage and Monitoring Strategies for Children. University of Liverpool; 2016.
26. Saint GL, Semple MG, Sinha I, Hawcutt DB. Optimizing the Dosing of Intravenous Theophylline in Acute Severe Asthma in Children. Paediatr Drugs. 2018;20(3):209–14. Available from: https://pubmed.ncbi.nlm.nih.gov/29302790
27. Cooney L, McBride A, Lilley A, Sinha I, Johnson TN, Hawcutt DB. Using pharmacokinetic modelling to improve prescribing practices of intravenous aminophylline in childhood asthma exacerbations. Pulm Pharmacol & Ther. 2017;43:6–11. Available from: http://dx.doi.org/10.1016/j.pupt.2017.01.007
28. Mitra A, Bassler D, Goodman K, Lasserson TJ, Ducharme FM. Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators. Evidence-Based Child Heal A Cochrane Rev J. 2006;1(1):101–46. Available from: http://dx.doi.org/10.1002/ebch.1
29. Mitra A, Bassler D, Goodman K, Lasserson TJ, Ducharme FM. Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators. Cochrane database Syst Rev. 2005;2005(2):CD001276–CD001276. Available from: https://pubmed.ncbi.nlm.nih.gov/15846615
2. Serebrisky D, Wiznia A. Pediatric Asthma: A Global Epidemic. Ann Glob Heal. 2019;85(1):6. Available from: https://pubmed.ncbi.nlm.nih.gov/30741507
3. Singhi S, Grover S, Bansal A, Chopra K. Randomised comparison of intravenous magnesium sulphate, terbutaline and aminophylline for children with acute severe asthma. Acta Paediatr. 2014;103(12):1301–6. Available from: http://dx.doi.org/10.1111/apa.12780
4. Lorensia A, Ikawati Z, Andayani TM, Maranatha D, Wahjudi M. Comparison of Electrolyte Disturbance of Using Intravenous Aminophylline Versus Nebulization Salbutamol for Exacerbation Asthma in Surabaya, Indonesia. Int J Pharm Clin Res. 2016;8(4):221–8.
5. Aralihond A, Shanta Z, Pullattayil A, Powell CVE. Treating acute severe asthma attacks in children: using aminophylline. Breathe (Sheffield, England). 2020;16(4):200081. Available from: https://pubmed.ncbi.nlm.nih.gov/33664832
6. Craig S, Powell CVE, Nixon GM, Oakley E, Hort J, Armstrong DS, et al. Treatment patterns and frequency of key outcomes in acute severe asthma in children: a Paediatric Research in Emergency Departments International Collaborative (PREDICT) multicentre cohort study. BMJ open Respir Res. 2022;9(1):e001137. Available from: https://pubmed.ncbi.nlm.nih.gov/35301198
7. Pike KC, Levy ML, Moreiras J, Fleming L. Managing problematic severe asthma: beyond the guidelines. Arch Dis Child. 2017;103(4):392–7. Available from: http://dx.doi.org/10.1136/archdischild-2016-311368
8. Wong JJM, Lee JH, Turner DA, Rehder KJ. A review of the use of adjunctive therapies in severe acute asthma exacerbation in critically ill children. Expert Rev Respir Med. 2014;8(4):423–41. Available from: http://dx.doi.org/10.1586/17476348.2014.915752
9. Ikatan Dokter Anak Indonesia. Pedoman Nasional Asma Anak. Edisi Kedu. Noenoeng R, Kartasasmita CB, Supriyanto B, Setyanto DB, editors. Jakarta: IDAI; 2016. 423–41 p.
10. Papanicolaou A, Wang H, Satzke C, Vlahos R, Wilson N, Bozinovski S. Novel Therapies for Pneumonia-Associated Severe Asthma Phenotypes. Trends Mol Med. 2020;26(11):1047–58. Available from: http://dx.doi.org/10.1016/j.molmed.2020.07.006
11. Sandrock CE, Norris A. Infection in Severe Asthma Exacerbations and Critical Asthma Syndrome. Clin Rev Allergy & Immunol. 2014;48(1):104–13. Available from: http://dx.doi.org/10.1007/s12016-014-8435-x
12. Craig SS, Dalziel SR, Powell CV, Graudins A, Babl FE, Lunny C. Interventions for escalation of therapy for acute exacerbations of asthma in children: an overview of Cochrane Reviews. Cochrane database Syst Rev. 2020;8(8):CD012977–CD012977. Available from: https://pubmed.ncbi.nlm.nih.gov/32767571
13. Castro-Rodriguez JA, Rodrigo GJ, Rodríguez-Martínez CE. Principal findings of systematic reviews of acute asthma treatment in childhood. J Asthma. 2015;52(10):1038–45. Available from: http://dx.doi.org/10.3109/02770903.2015.1033725
14. Morris I, Lyttle MD, O’Sullivan R, Sargant N, Doull IJM, Powell CVE. Which intravenous bronchodilators are being administered to children presenting with acute severe wheeze in the UK and Ireland? Thorax. 2014;70(1):88–91. Available from: http://dx.doi.org/10.1136/thoraxjnl-2014-206041
15. Lyttle MD, O’Sullivan R, Doull I, Hartshorn S, Morris I, Powell CVE. Variation in treatment of acute childhood wheeze in emergency departments of the United Kingdom and Ireland: an international survey of clinician practice. Arch Dis Child. 2014;100(2):121–5. Available from: http://dx.doi.org/10.1136/archdischild-2014-306591
16. Reddel HK, Bacharier LB, Bateman ED, Brightling CE, Brusselle GG, Buhl R, et al. Global Initiative for Asthma Strategy 2021. Respirology. 2022;27(1):14–35. Available from: https://doi.org/10.1111/resp.14174
17. Cooney L, Sinha I, Hawcutt D. Aminophylline Dosage In Asthma Exacerbations in Children: A Systematic Review. PLoS One. 2016;11(8):e0159965–e0159965. Available from: https://pubmed.ncbi.nlm.nih.gov/27483163
18. Yung M, South M. Randomised controlled trial of aminophylline for severe acute asthma. Arch Dis Child. 1998;79(5):405–10. Available from: https://pubmed.ncbi.nlm.nih.gov/10193252
19. Silveira D’Ávila R, Piva JP, José Cauduro Marostica P, Luís Amantea S. Early administration of two intravenous bolus of aminophylline added to the standard treatment of children with acute asthma. Respir Med. 2008;102(1):156–61. Available from: http://dx.doi.org/10.1016/j.rmed.2007.07.030
20. Zaheer A, Hayat H, Hussain F, Gohar R, Ali AS. Comparison of the effects of intravenous magnesium sulphate versus intravenous aminophylline in acute attack of asthma in Pediatric Emergency Department, Lahore General Hospital, Lahore. Pakistan Postgrad Med J. 2021;30(03):120–4. Available from: http://dx.doi.org/10.51642/ppmj.v30i03.318
21. Mahemuti G, Zhang H, Li J, Tieliwaerdi N, Ren L. Efficacy and side effects of intravenous theophylline in acute asthma: a systematic review and meta-analysis. Drug Des Devel Ther. 2018;12:99–120. Available from: https://pubmed.ncbi.nlm.nih.gov/29391776
22. Neame M, Aragon O, Fernandes RM, Sinha I. Salbutamol or aminophylline for acute severe asthma: how to choose which one, when and why? Arch Dis Child - Educ & Pract Ed. 2015;100(4):215–22. Available from: http://dx.doi.org/10.1136/archdischild-2014-306186
23. Nakano J, Yano T, Yamamura K, Yoshihara H, Ohbayashi O, Yamashita N, et al. Aminophilline suppress the release of chemical mediators in treatment of acute asthma. Respir Med. 2006;100(3):542–50. Available from: http://dx.doi.org/10.1016/j.rmed.2005.05.023
24. Anderson M. The properties of aminophylline. Emerg Nurse. 2007;15(7):24–7. Available from: http://dx.doi.org/10.7748/en2007.11.15.7.24.c6254
25. Cooney L. Aminophylline: Developing Evidence Based Dosage and Monitoring Strategies for Children. University of Liverpool; 2016.
26. Saint GL, Semple MG, Sinha I, Hawcutt DB. Optimizing the Dosing of Intravenous Theophylline in Acute Severe Asthma in Children. Paediatr Drugs. 2018;20(3):209–14. Available from: https://pubmed.ncbi.nlm.nih.gov/29302790
27. Cooney L, McBride A, Lilley A, Sinha I, Johnson TN, Hawcutt DB. Using pharmacokinetic modelling to improve prescribing practices of intravenous aminophylline in childhood asthma exacerbations. Pulm Pharmacol & Ther. 2017;43:6–11. Available from: http://dx.doi.org/10.1016/j.pupt.2017.01.007
28. Mitra A, Bassler D, Goodman K, Lasserson TJ, Ducharme FM. Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators. Evidence-Based Child Heal A Cochrane Rev J. 2006;1(1):101–46. Available from: http://dx.doi.org/10.1002/ebch.1
29. Mitra A, Bassler D, Goodman K, Lasserson TJ, Ducharme FM. Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators. Cochrane database Syst Rev. 2005;2005(2):CD001276–CD001276. Available from: https://pubmed.ncbi.nlm.nih.gov/15846615