Efficacy and side effects of intravenous theophylline in acute asthma: a systematic review and meta-analysis
Gulixian Mahemuti, Hui Zhang, Jing Li, Nueramina Tieliwaerdi, Lili Ren Respiratory Department, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province, People’s Republic of China Background and objective: Theophylline has been used for decades to treat bo...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2018-01-01
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| Series: | Drug Design, Development and Therapy |
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| Online Access: | https://www.dovepress.com/efficacy-and-side-effects-of-intravenous-theophylline-in-acute-asthma--peer-reviewed-article-DDDT |
| _version_ | 1819107236981506048 |
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| author | Mahemuti G Zhang H Li J Tieliwaerdi N Ren L |
| author_facet | Mahemuti G Zhang H Li J Tieliwaerdi N Ren L |
| author_sort | Mahemuti G |
| collection | DOAJ |
| description | Gulixian Mahemuti, Hui Zhang, Jing Li, Nueramina Tieliwaerdi, Lili Ren Respiratory Department, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province, People’s Republic of China Background and objective: Theophylline has been used for decades to treat both acute and chronic asthma. Despite its longevity in the practitioner’s formulary, no detailed meta-analysis has been performed to determine the conditions, including concomitant medications, under which theophylline should be used for acute exacerbations of asthma. We aimed to quantify the usefulness and side effects of theophylline with or without ethylene diamine (aminophylline) in acute asthma, with particular emphasis on patient subgroups, such as children, adults, and concomitant medications.Methods: We searched PubMed, EMBASE, The Cochrane Library, ClinicalTrials.gov, and the WHO Clinical Trials Registry for randomized, controlled clinical trials. We planned a priori subgroup analyses by time post-medication, concomitant medication, control type, and age.Results: We included 52 study arms from 42 individual trials. Of these, 29 study arms included an active control, such as adrenaline, beta-2 agonists, or leukotriene receptor antagonists, and 23 study arms compared theophylline (with or without ethylene diamine) with placebo or no drug. Theophylline significantly reduced heart rate when compared with active control (p=0.01) and overall duration of stay (p=0.002), but beta-2 agonists were superior to theophylline at improving forced expiratory volume in one second (FEV1) (p=0.002). Theophylline was not significantly different from other drugs in its effects on respiratory rate, forced vital capacity (FVC), peak expiratory flow rate, admission rate, use of rescue medication, oxygen saturation, or symptom score. Closer examination of the data revealed that the medications given in addition to theophylline or control significantly changed the effectiveness of theophylline (subgroup difference: p<0.00001).Conclusion: Given the low cost of theophylline, and its similar efficacy and rate of side effects compared with other drugs, we suggest that theophylline, when given with bronchodilators with or without steroids, is a cost-effective and safe choice for acute asthma exacerbations. Keywords: theophylline, theophylline with ethylene diamine, aminophylline, asthma, bronchodilators, beta-2 agonists, adrenaline, FEV, PEFR, affordable drugs |
| first_indexed | 2024-12-22T02:50:50Z |
| format | Article |
| id | doaj.art-3f20ff08d0234f9f861850406bd293b2 |
| institution | Directory Open Access Journal |
| issn | 1177-8881 |
| language | English |
| last_indexed | 2024-12-22T02:50:50Z |
| publishDate | 2018-01-01 |
| publisher | Dove Medical Press |
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| series | Drug Design, Development and Therapy |
| spelling | doaj.art-3f20ff08d0234f9f861850406bd293b22022-12-21T18:41:24ZengDove Medical PressDrug Design, Development and Therapy1177-88812018-01-01Volume 129912036318Efficacy and side effects of intravenous theophylline in acute asthma: a systematic review and meta-analysisMahemuti GZhang HLi JTieliwaerdi NRen LGulixian Mahemuti, Hui Zhang, Jing Li, Nueramina Tieliwaerdi, Lili Ren Respiratory Department, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Province, People’s Republic of China Background and objective: Theophylline has been used for decades to treat both acute and chronic asthma. Despite its longevity in the practitioner’s formulary, no detailed meta-analysis has been performed to determine the conditions, including concomitant medications, under which theophylline should be used for acute exacerbations of asthma. We aimed to quantify the usefulness and side effects of theophylline with or without ethylene diamine (aminophylline) in acute asthma, with particular emphasis on patient subgroups, such as children, adults, and concomitant medications.Methods: We searched PubMed, EMBASE, The Cochrane Library, ClinicalTrials.gov, and the WHO Clinical Trials Registry for randomized, controlled clinical trials. We planned a priori subgroup analyses by time post-medication, concomitant medication, control type, and age.Results: We included 52 study arms from 42 individual trials. Of these, 29 study arms included an active control, such as adrenaline, beta-2 agonists, or leukotriene receptor antagonists, and 23 study arms compared theophylline (with or without ethylene diamine) with placebo or no drug. Theophylline significantly reduced heart rate when compared with active control (p=0.01) and overall duration of stay (p=0.002), but beta-2 agonists were superior to theophylline at improving forced expiratory volume in one second (FEV1) (p=0.002). Theophylline was not significantly different from other drugs in its effects on respiratory rate, forced vital capacity (FVC), peak expiratory flow rate, admission rate, use of rescue medication, oxygen saturation, or symptom score. Closer examination of the data revealed that the medications given in addition to theophylline or control significantly changed the effectiveness of theophylline (subgroup difference: p<0.00001).Conclusion: Given the low cost of theophylline, and its similar efficacy and rate of side effects compared with other drugs, we suggest that theophylline, when given with bronchodilators with or without steroids, is a cost-effective and safe choice for acute asthma exacerbations. Keywords: theophylline, theophylline with ethylene diamine, aminophylline, asthma, bronchodilators, beta-2 agonists, adrenaline, FEV, PEFR, affordable drugshttps://www.dovepress.com/efficacy-and-side-effects-of-intravenous-theophylline-in-acute-asthma--peer-reviewed-article-DDDTTheophyllinetheophylline with ethylene diamineaminophyllineasthmabronchodilatorsbeta-2 agonistsadrenalineFEVPEFRaffordable drugs |
| spellingShingle | 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 Design, Development and Therapy Theophylline theophylline with ethylene diamine aminophylline asthma bronchodilators beta-2 agonists adrenaline FEV PEFR affordable drugs |
| title | Efficacy and side effects of intravenous theophylline in acute asthma: a systematic review and meta-analysis |
| title_full | Efficacy and side effects of intravenous theophylline in acute asthma: a systematic review and meta-analysis |
| title_fullStr | Efficacy and side effects of intravenous theophylline in acute asthma: a systematic review and meta-analysis |
| title_full_unstemmed | Efficacy and side effects of intravenous theophylline in acute asthma: a systematic review and meta-analysis |
| title_short | Efficacy and side effects of intravenous theophylline in acute asthma: a systematic review and meta-analysis |
| title_sort | efficacy and side effects of intravenous theophylline in acute asthma a systematic review and meta analysis |
| topic | Theophylline theophylline with ethylene diamine aminophylline asthma bronchodilators beta-2 agonists adrenaline FEV PEFR affordable drugs |
| url | https://www.dovepress.com/efficacy-and-side-effects-of-intravenous-theophylline-in-acute-asthma--peer-reviewed-article-DDDT |
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