Aminophylline therapy for acute bronchospastic disease in the emergency room

Article Abstract:

Aminophylline is an intravenous drug that has traditionally been used to treat asthma and chronic obstructive pulmonary disease, because it has the ability to open up narrowed airways. It also has a number of side effects, some of which are very serious, such as rapid heartbeats and seizures. Less serious side effects include tremor, nausea, and anxiety. The effectiveness of aminophylline has been questioned in recent years. Because of these concerns and its serious side effects, there has been a decline in its use. Some clinicians suggest that aminophylline should not be used in the emergency room. A study was designed to determine if aminophylline therapy was beneficial in emergency treatment of asthma. Patients coming into the emergency room with acute exacerbations of their asthma, who had not taken an aminophylline preparation in the previous 24 hours, were randomly assigned to receive standard therapy, and then divided into two groups; one received aminophylline and the other was given a placebo. Breathing tests were performed 60 and 120 minutes after the start of the intravenous treatments. When the two groups were compared no differences were found in the improvement (or lack thereof) in breathing tests, patient satisfaction with breathing improvement, side effects, time spent in the emergency room, or the doctor's perception of the patient's clinical status. However, despite the absence of any clear evidence of beneficial effects of this drug, a significant difference was found in the groups' rates of hospitalization. While only 6 percent of the aminophylline group required hospital admission, 21 percent of those who received placebo were admitted. Although aminophylline has a number of other effects, including a mild anti-inflammatory effect, increasing the efficiency of heart contractions, and making the diaphragm work more effectively, none of these is strong enough to create an obvious advantage. If the results of this study are reproduced, a strong argument can be made for using aminophylline as the first line of emergency treatment for asthma. A similar reduction in the hospital admission rate could result in saving half a billion dollars per year. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation

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Methylxanthines in the treatment of asthma: the rise, the fall, and the possible rise again

Article Abstract:

Drugs in the methylxanthine category that are used to treat asthma include intravenous aminophylline and oral theophylline. When these drugs were first introduced several decades ago, they were widely used for asthma, in part because they were among the few drugs available, they were at least partially efficacious, and the formulations that existed then caused few serious side effects. Newer formulations of these drugs tend to accumulate in the bloodstream, and can cause serious side effects when the blood levels reach toxic ranges. In recent years, studies have suggested that aminophylline and theophylline are ineffective in treating in acute asthma attacks. Combined with their known toxicity, this finding led to a decline in their popularity. However, a new study by Wrenn and colleagues, published in the August 15, 1991 issue of Annals of Internal Medicine, has shown that for unknown reasons, the use of aminophylline in emergency room treatment of an acute asthma attack can reduce the number of hospitalizations for asthma. No significant differences were found between the patients who were given aminophylline and those who were not. Thus, this study may signal a need for another re-evaluation of the efficacy of the methylxanthines in the treatment of acute asthma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, History, Xanthine

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Foot problems in homeless persons

Article Abstract:

Foot problems represent up to 20 percent of the medical complaints of homeless persons. Other conditions that commonly occur among the homeless are traumatic disorders, ulcers, and infections. Immersion foot, or trench foot, which comes from wearing wet shoes, and frostbite are also common problems. Trauma can be major, in the form of fractures, or minor, as a result of standing for long periods of time in poorly fitting shoes. Foot ulcers can be caused by poor venous circulation, often the result of sleeping sitting upright, or neurological disorders, such as those which result from alcoholism and malnutrition. The infections the homeless contract include bacterial cellulitis, parasites such as scabies, and fungal infestations. Foot problems are often neglected by the homeless and by their health care providers because of the often greater problems of finding food and shelter and more obvious and pressing medical problems. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Abnormalities, Homeless persons, Foot, Foot diseases, Foot deformities

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