Inhaled Albuterol and Oral Prednisone Therapy in Hospitalized Adult Asthmatics: Discussion (1)

The lack of benefit of aminophylline therapy observed in this study is consistent with previous emergency room investigations. In both the placebo and aminophylline groups, there were highly significant improvements over time, including spirometry and subjective patient ratings. It is noteworthy that both groups had a duration of hospital stay less than half the national average of 4.8 days. This finding cannot be attributed to a lack of severity of illness at baseline, but rather to the specific albuterol and prednisone regimen used in this study. If our mean hospital stay of roughly two days less than the US national average is applied to potential cost savings (assume $200 per day bed charge for about 450,000 admissions), $180 million could be saved annually.
Based on current theories of acute bronchospasm and inflammation in asthma, our findings are not surprising. Intensive inhaled beta agonists provide bronchodilation that is not enhanced by aminophylline in the ER. Glucocorticoids in relatively large doses effectively treat the inflammatory component of acute asthma. A study similar to ours in chronic obstructive pulmonary disease other than asthma found no. significant benefit of aminophylline when added to otherwise standard therapies.

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