Inhaled Albuterol and Oral Prednisone Therapy in Hospitalized Adult Asthmatics: Discussion (2)

Inhaled Albuterol and Oral Prednisone Therapy in Hospitalized Adult Asthmatics: Discussion (2)Although a larger study might show a small benefit of aminophylline therapy, any potential benefits must be weighed against the risk of serious adverse effects. Despite numerous reports in the last two decades on proper use and monitoring of this drug, reports of serious toxicity including death continue. Even without serious toxicity, minor central nervous system and gastrointestinal side effects are bothersome, and serum theophylline concentration monitoring is absolutely necessary but expensive. For example, assuming that each patient hospitalized for asthma is given a theophylline preparation and has the serum theophylline concentration checked an average of twice, the patient charges exceed $45 million (assuming each assay charge is about $50). Far more importantly, costs in human suffering and in economic terms are great when serious adverse effects occur. canadian family pharmacy
Further investigation is needed to establish with certainty that aminophylline does not add significant benefit to other optimal therapies for subgroups of patients. A meta-analysis of this literature was recently reported. However, since our results are consistent with emergency room studies and because of new knowledge of the value of intensive beta agonist aerosols, glucocorticoids, and anticholinergic therapy in acute asthma, we believe substantive questions have been raised about the automatic, initial use of aminophylline in hospitalized adult asthmatics. Considering the questionable efficacy, adverse effects, and costs associated with aminophylline, we feel the routine use of this drug in hospitalized adult asthmatics is not justified.

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