Abstract
Background
Aminophylline may have a role in the management of COPD, stable as well as exacerbating, but its use remains controversial, mainly due to its narrow therapeutic window. We tried to assess whether it has a role in management of acute exacerbations of COPD under monitored conditions.
Objective
To assess safety, tolerability and clinical effects of aminophylline infusion in treatment of acute exacerbation of COPD: ACUTE study (Aminophylline in COPD- utility and Treatment effects).
Methods
The ACUTE study enrolled patients with documented COPD exacerbation with persistent hypoxia and hypercarbia despite 48 hours of maximal standard therapy including non-invasive ventilation. They were matched with a historical cohort of patients who had not received aminophylline. A slow loading infusion of Aminophylline (6 mg/kg) was administered followed by a maintenance dose 0.5 mg per kg over 24 hours under monitored conditions. We assessed length of stay in hospital as the primary outcome. Our null hypothesis for the study was that there was no difference in hospital length of stay in hypercapnic and hypoxic exacerbating COPD patients who received an aminophylline infusion, when compared with matched historical controls.
Results
The study did not meet its primary end point of a difference in hospital length of stay which was similar in patients receiving aminophylline treatment and those who did not. However, there was a significant improvement in oxygenation (P/F ratio) after 48 hours of aminophylline treatment. pCO2 levels on ABG also demonstrated a significant decrease after 48 hours of aminophylline infusion. Dyspnoea severity score, ICU length of stay did not significantly improve after 48 hours of aminophylline infusion. Adverse events, including nausea, tachycardia, and seizures, were reported in the group receiving aminophylline. There was no significant difference in baseline parameters like pH, oxygenation and PaCO2 levels between the matched groups.
Conclusion
Though aminophylline infusion did not significantly impact the length of hospital stay, it improved oxygenation and reduced PaCO2 levels in hypercapnic and hypoxic exacerbating COPD patients.
References
- 1.Duffy N, Walker P, Diamantea F, Calverley PM, Davies L. Intravenous aminophylline in patients admitted to hospital with non-acidotic exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial. Thorax. 2005;60(9):713–717. doi: 10.1136/thx.2004.036046. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Barr RG, Rowe BH, Camargo CA. Methylxanthines for exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2003;(Issue 2):CD002168. doi: 10.1002/14651858.CD002168. Art. No.: Accessed 06 November 2021. [DOI] [PubMed] [Google Scholar]
- 3.Barnes PJ. Theophylline. Am J Respir Crit Care Med. 2013 Oct 15;188(8):901–6. doi: 10.1164/rccm.201302-0388PP. 23672674 [DOI] [PubMed] [Google Scholar]