Doses of selected emergency drugs

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Editor, – Australian Prescriber Vol. 19 No. 4 1996 was accompanied by a card entitled 'Doses of selected emergency drugs'. Aminophylline was recommended for asthma not responding to nebulised salbutamol. The Canadian Medical Association Journal recently published guidelines for the emergency management of asthma.1 These guidelines were developed using an evidence-based medicine approach. The recommendation not to use aminophylline in the setting of the emergency department was grade A based on a meta-analysis of the results of 9 level I trials and 4 level II trials.2 The use of aminophylline appears to be associated with an increased risk of adverse effects. Aminophylline may have a role in the treatment of patients with severe acute asthma once the initial crisis in the emergency department has passed.

Joel Lexchin
Doctor of Medicine
Toronto, Ontario
Canada

Editorial note:

Dr Lexchin's letter was referred to Professor J.P. Seale who represents the Thoracic Society of Australia and New Zealand on the Advisory Editorial Panel of Australian Prescriber. Professor Seale concurs with Dr Lexchin. He also points out that the guidelines of the National Asthma Campaign3 state that the benefits of aminophylline are uncertain and so it should be reserved for adults who are unresponsive to maximal doses of beta2 agonists. The guidelines consider aminophylline to be unnecessary in the treatment of acute asthma in children.

References

  1. Beveridge RC, Grunfeld AF, Hodder RV, Verbeek PR. Guidelines for the emergency management of asthma in adults. CAEP/CTS Asthma Advisory Committee. Canadian Association of Emergency Physicians and the Canadian Thoracic Society. Can Med Assoc J 1996;155:25-37.
  2. Littenberg B. Aminophylline treatment in severe acute asthma. A meta-analysis. JAMA 1988;259:1678-84.
  3. National Asthma Campaign. Asthma management handbook.3rd ed. Melbourne: National Asthma Campaign, 1996.