Effect of aminophylline when added to metaproterenol sulfate and beclomethasone dipropionate aerosol

Twenty-one patients with frequently recurrent severe asthma were treated for 2 wk with placebo capsules and metaproterenol sulfate aerosol therapy followed by beclomethasone dipropionate aerosol therapy sequentially inhaled every 4 to 6 hr and for 2 wk with the same aerosols and aminophylline therapy added. Treatment was double-blind, and the therapy regimens were administered in a random sequence. Patients measured their PEFR at home before and after aerosol inhalation three times a day. The mean PEFRs before inhalation of aerosol were significantly higher when patients were receiving aminophylline therapy. In 86% of the patients, the mean PEFR that was measured after inhalation of metaproterenol sulfate was 11% greater when they were also receiving aminophylline therapy, but this difference was not significant. In 14% of the patients, however, postaerosol inhalation PEFRs were significantly higher (50% to 80%) after aminophylline therapy was added to aerosol therapy. PEFRs were always lowest in the early morning, regardless of the therapy administered. Therapy regimens that contained aminophylline were associated with less dyspnea but produced more adverse side effects and were more costly. Thus in most patients the favorable effect that aminophylline therapy produced by raising baseline PEFRs and attenuating dyspnea should be balanced against the adverse effects this medication also produced, since in most patients aminophylline therapy did not significantly enhance postinhalation PEFRs.

Theophylline compounds in patients with reversible airways obstruction

In a double blind cross-over comparison of a single dose 450-mg slow-release aminophylline (SRA) with placebo in eleven patients with stable, reversible airways obstruction SRA produced significantly greater increase in FEV1 and vital capacity from 2 to 9 hr after administration. A second double-blind cross-over comparison of 450-mg SRA with 400 mg of choline theophyllinate (CT) in eleven similar patients showed that SRA produced a slower rise in FEV1 and VC than CT. However, the increase in spirometric readings following SRA was sustained at 9 hr after administration where the spirometric recordings after CT were falling. Whereas CT produced a peak value in plasma theophylline at 1 hr, the highest values after SRA occurred at 4 or 8 hr after administration. The plasma theophylline level at 8 hr after SRA was significantly higher than that following CT. In this single-dose study, plasma theophylline levels obtained were within the normal therapeutic range and this was not exceeded and no side effects were recorded.

Comparative study of the effects of intravenous administration of aminophylline, salbutamol and terbutaline in patients suffering from reversible airways obstruction

A study was carried out in 20 patients with reversible airways obstruction to compare the bronchodilator potency of salbutamol (250 micrograms), terbutaline (500 micrograms) and aminophylline (250 mg), given by slow intravenous injection. Patients received each of the three treatments, on separate days, in random order using a double-blind design. Measurements were made of pulmonary function, pulse rate and blood pressure and side-effects were recorded before and at intervals up to 4 hours after drug administration. All three drugs improved pulmonary function to a significant degree and this effect was observed at 5 minutes post-treatment and lasted for 3 hours. Terbutaline and salbutamol had a significantly greater effect than aminophylline, but there was no difference between salbutamol and terbutaline. Both salbutamol and terbutaline produced tachycardia of a similar magnitude, and which returned to initial values within 90 minutes post-injection. Aminophylline did not cause tachycardia and this difference compared with the beta-agonists on pulse rate was statistically significant (p less than 0.001). Salbutamol caused a significantly greater incidence of palpitations than did either aminophylline (p less than 0.01) or terbutaline (p less than 0.05). No other differences between treatments were observed.

Pharmacokinetics and bronchodilatory effect of proxyphylline and theophylline

In a double-blind cross-over study, including double-dummy placebo, 8 adult asthmatics received oral sustained-release proxyphylline 900 mg (Neofyllin retard) twice daily, or 250 mg microcrystalline theophylline (Nuelin) 4 times daily for 6 days. It was found that there was a reduction in the number of bronchodilatory aerosol dosages used with both proxyphylline treatment (139 dosages) and theophylline treatment (165) dosages, but only with proxyphylline was the difference in number statistically significant when compared with the placebo period (236 dosages, p less than 0.05). Subjective side-effects occurred significantly more often during theophylline treatment than during proxyphylline treatment (p less than 0.05). Changes in lung function after intravenous infusion of proxyphylline 1400 mg and aminophylline 400 mg confirmed the potency difference between the drugs. Volume of distribution and total body clearance were comparable for the two drugs. In 2 subjects, calculations of the fraction of drug absorbed and plasma-concentration versus time curves after oral and intravenous administration, suggested saturation kinetics of theophylline.

[Treatment of status asthmaticus. Prospective evaluation of a protocol combining aminophylline and terbutaline (44 cases)]

The treatment of status asthmaticus remains poorly defined. Even the definition of the condition is controversial. We have therefore attempted to define a therapeutic protocol consisting of a combination of terbutaline, aminophylline and hydrocortisone administered parenterally. We have conducted a prospective evaluation of the effectiveness and tolerance of this protocol. 44 consecutive patients with status asthmaticus (defined as an abnormally severe episode of asthma with early or marked alveolar hypoventilation: PaCO2 greater than or equal to 5.20 kPa) were entered into the study over a period of 56 months. The effectiveness of this combination is reflected by the rapid improvement in the clinical and blood gas parameters, the relatively rare use of mechanical ventilation (of brief duration) and the low mortality. The tolerance proved to be excellent, as the terbutaline only had to be stopped in 1 case (permanently) and the aminophylline in one other case (temporarily). These initial results encourage us to a more aggressive approach in the early treatment of status asthmaticus with particular attention to the associated metabolic acidosis.

[Effect of euphylline on the cyclic nucleotide content and cAMP phosphodiesterase activity of the lymphocytes of bronchial asthma patients]

The content of cAMP, cGMP and cAMP phosphodiesterase activity were studied in lymphocytes of bronchial asthma patients and normal persons before and 15 min after euphylline administration in a dose of 4 mg/kg. The cAMP/cGMP ratio was significantly lowered in patients. Euphylline administration led to its significant increase. In normal persons, this ratio remained unchanged. Some patients manifested an elevated activity of cAMP phosphodiesterase. In these cases, administration of euphylline brought about a significant increase in cAMP level in lymphocytes in the presence of the lowered activity of the enzyme phosphodiesterase. In the remaining patients and in normal persons, these indicators did not significantly change. It is suggested that the mechanism of euphylline action is dependent on cAMP phosphodiesterase activity.

A comparative trial of choline theophyllinate and controlled release aminophylline in chronic childhood asthma

A comparison of pharmacokinetics and therapeutic effects of a standard oral theophylline preparation (Choline Theophyllinate) and controlled release aminophylline (Phyllocontin) was made in two parallel double blind trials in 25 children with chronic asthma. Fourteen children entered a double blind cross-over trial; the remaining 11 were allocated to a parallel trial with no change of theophylline preparation throughout. Sustained plasma theophylline levels were observed with the controlled release preparation in contrast to the low morning levels obtained with Choline Theophyllinate. No significant differences were found for peak theophylline levels, morning or evening peak flow rates or required access to other bronchodilators. However nocturnal symptoms were significantly reduced and daytime activity scores improved (P less than 0.05) on the controlled release preparation. The sustained plasma theophylline levels found in children taking the controlled release aminophylline may have provided a small but useful therapeutic advantage over the standard preparation.

Essential tremor--successful treatment with aminophylline. A case report

In a patient suffering from essential tremor, treatment with aminophylline resulted in complete and sustained remission of symptoms. This observation supports a central origin of essential tremor and suggests that brain nucleotides (cyclic adenosine monophosphate, cyclic guanosine monophosphate) may be important in the pathogenesis of this condition.

Undetected episodes of prolonged apnea and severe bradycardia in preterm infants

Twenty-four-hour tape recordings of ECG and breathing movement were made on 14 preterm infants with prolonged apneic episodes. Despite apnea monitoring systems, 136/203 (67%) apneic episodes greater than or equal to 20 seconds in duration, including 19 episodes greater than or equal to 50 seconds in duration, were not recorded by nursing staff. Of 120 apneic episodes greater than or equal to 30 seconds, 100 (89%) were accompanied by bradycardia less than or equal to 100 beats per minute. Episodes of more marked bradycardia (less than or equal to 80 beats per minute and up to seven minutes in duration) occurred without cessation of breathing movement in 10/14 infants studied. Treatment with theophylline or aminophylline was associated with a reduction in the number of episodes of apnea greater than or equal to 20 seconds accompanied by bradycardia less than or equal to 80 beats per minute (P less than .001). Many prolonged episodes of apnea and bradycardia are going unnoticed in neonatal intensive care units. Further studies are required to investigate and overcome the causes of these failures.

Bronchodilator response to oral aminophylline and terbutaline versus aerosol albuterol in patients with chronic obstructive pulmonary disease

Bronchodilator efficacy of oral administration of aminophylline (400 mg) and terbutaline sulfate (5 mg) was compared with inhalation of three puffs of albuterol sulfate in 17 patients with stable chronic obstructive pulmonary disease in a double-blind crossover study. Two hours after either form of therapy, the patients were treated again with three puffs of albuterol. Forced expiratory volume in one second (FEV1) increased significantly more from the baseline value after albuterol aerosol than after oral medication at 30, 60, and 120 minutes (paired t test, p less than 0.01). After three puffs of albuterol at 120 minutes, FEV1 increased to similar values an hour later on both days in 14 of 17 patients. Thirteen patients complained of side effects during oral therapy and none during aerosol therapy. Maximum bronchodilatation was achieved by albuterol aerosol in 14 of 17 patients, and addition of oral therapy produced no further increase of flow rate in these patients. Bronchodilator aerosol is the logical choice for treatment of chronic obstructive pulmonary disease because it is more effective than oral therapy and because it is free from side effects.

Management of the acute asthma attack at home

Asthma is a disease of remission and exacerbation but the combination of optimal interval therapy with early aggressive self initiated medication during deterioration (particularly oral corticosteroids) should prevent the crises which require emergency intervention. The first and last words in acute asthma management must be prevention and prevention.

[Effect of the adrenaline, euphyllin, phentolamine and obzidan on serotonin bronchospasm in guinea pigs]

It has been shown in experiments on 81 guinea-pigs that variation of the functional status of alpha- and beta-adrenoreceptors produces a substantial effect on marked serotonin bronchospasm. The blockade of beta-adrenoreceptors with obsidan (1--2 mg/kg) increases the spasm of bronchial smooth muscles in response to serotonin (10 micrograms/kg). The alpha-adrenolytic phentolamine (2 mg/kg) and the myotropic spasmolytic euphylline (8 mg/kg) remove the hypersensitivity of the bronchi to serotonin 20 min after adrenaline administration and potentiate its protective effect in serotonin bronchospasm after administering the beta-adrenoblocker obsidan.

[Comparison of 2 theophylline delayed-action preparations of different galenic forms]

Serum concentrations of Theophylline were measured in patients with reversible airways-obstruction during oral and intravenous treatment. The comparison of two sustained-release preparations of Aminophylline (Euphyllin retard 350 mg, Mundiphyllin retard 225 mg), administered according to a randomised study, shows no significant difference. Plasma levels from 5 to 20 mg/l were measured after five days of treatment with either preparation given in average dosage of 10 mg Theophylline per kg body weight. Similar plasma levels, which are associated with therapeutic effects, were measured after the intravenous application of the same dose of Theophylline over 24 hours.

Inhibition of stress ulcer formation by aminophylline in rats

The preventive effect of aminophylline in the development of stress ulcer by cold restraint was examined in Sprague-Dawley rats. Aminophylline, in a dose of 0.5 mg/kg, significantly inhibited stress ulcer formation in comparison to the control group. The preventative effect of aminophylline appeared to result from the inhibition of thrombus formation produced by the inhibition of platelet aggregation.

Acute alveolar edema

The interrelationships of several important factors contribute to the development of pulmonary edema. These factors include hydrostatic and osmotic forces, capillary membrane permeability, and lymphatic drainage capacity. Whether the pulmonary edema is cardiogenic or noncardiogenic, optimal management is facilitated by the improvement of ventilation and gas exchange within the lungs and the restoration of oxygen transport to peripheral tissues. The keystones in such therapy include the administration of oxygen, diuretics, and vasodilators; the use of mechanical ventilation; and the implementation of specific therapy directed toward underlying disorders.

Ventilatory dysfunction resulting from bilateral anterolateral high cervical cordotomy. Dual beneficial effect of aminophylline

Because of metastatic pain resistant to medical treatment after left pneumonectomy for squamous cell carcinoma, a 46-year-old patient underwent a bilateral cervical cordotomy at the C1-C2 anterolateral level, in two phases. The second intervention was followed by severe ventilatory problems requiring mechanical ventilation, and at a later stage, the implantation of a phrenic pacemaker on the right side. Analysis of the ventilatory pattern during spontaneous breathing and during phrenic pacing and measurement of the transdiaphragmatic pressure during phrenic nerve stimulation revealed the existence of a beneficial effect of aminophylline on both the regulation of ventilation and diaphragmatic contractility.

Aminophylline ameliorates glycerol-induced acute renal failure in rats

The effect of aminophylline (theophylline complexed with ethylenediamine) on the severity of glycerol-induced myohemoglobinuric acute renal failure was examined in rats. In the first series of experiments, one group of rats received twice daily injections of aminophylline following the induction of acute renal failure, and a second group (controls) received twice daily injections of saline. Only one of the aminophylline-injected rats but five of the saline-injected rats died during the 3-day follow-up period. Moreover, mean serum creatinine was lower in the aminophylline-injected rats than in the saline-injected controls on each of the 3 days, demonstrating that aminophylline reduced the renal functional impairment. In the second series, single injections of aminophylline were given at the time of glycerol injections or 3, 6, or 24 h later. As assessed by mean serum creatinine during the 3-day follow up, even single injections had protective effects if given during the initiation phase (0-3 h after glycerol). Since aminophylline dissociates into theophylline in biological fluids, and since theophylline is an adenosine-receptor antagonist, these observations are consistent with the hypothesis that adenosine plays a pathogenic role in myohemoglobinuric acute renal failure in rats.