Leopard
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young_doc wrote:
B.
Though if Theophylline (E) was given i.v., it would also have been an option. But given p.o., it would not act fast enough to treat an acute attack.
Methylxanthines are usually not recommended for acute attack ,no matter it is given PO or IV.
Their sustained release capsules have place in long term management of Bronchial asthma.
Best of luck
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| young_doc
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Leopard wrote:
Methylxanthines are usually not recommended for acute attack ,no matter it is given PO or IV.
Their sustained release capsules have place in long term management of Bronchial asthma.
Best of luck
Here we go again Leopold. Perhaps you would like a little reading.
"Theophylline injection helps to give relief in an acute attack for lung disorders such as asthma, bronchitis, or emphysema. Generic theophylline injections are available."
http://www.drugdigest.org/DD/DVH/Uses/0,3915,7585...
"For occasional patients, maintenance therapy with anhydrous theophylline extended-release 300 mg bid is recommended after an acute attack"
http://www.merck.com/mrkshared/mmanual/section18/...
"Our data suggested that theophylline acts on both the central and peripheral airways and that theophylline improves the airway obstruction in a dose-dependent fashion when the severity of acute attack is mild."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd...
"These medicines may be used for treatment of acute attack OR for chronic long-term treatment"
http://www.mayoclinic.com/health/drug-information...
As i said earlier, B is the answer, there's no doubt about that, BUT intravenous Theophylline "COULD" also be used. There is no need for you to disagree with that statement.
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| alexaE
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i would give corticosteroids
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| fox
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Alexa...it says oral corticosteroids. I dont think oral steroids has any role. Injected aminophyline would have been the best answer if it was on the list. Given choices I think ipratropium fits best
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| Leopard
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Dear Guys
Thank you very much for initiating this discussion.Before deciding something we should not forget a few things regarding use of theophyllin.
Once it was used very commonly but its use now is not that much common due to availability of better and comaratively safer medications.Never forget it is one those notorious drugs which have very narrow therapeutic window.
Whenever we talk about drug regimens ,it is understood that regimens used in USA
We should not forget three conditions of Bronchial asthma
- Acute exacerbation
- Long term controll Status asthimaticus
Each of the three has different management and different preferences
My first reference is CMDT (current medical diagnosis and treatment , Under the heading of Ashtma You can see the table named Table No 9-6"Quick relief medications of Asthma" . page 234 Edition 2003 The same table is quoted by "2005 Current consult Medicine "table 16 page 1215. Neither of them has mentioned Theophyllin as a drug to be used in acute exacerbation.
Second Reference : Washington's Manual of medical therapeutics page 248 says "Methylxanthines are not generally recommended".
Third Reference: While discussing management of acute exacerbation of Bronchial asthma Ferri in his book "practical guide to the care of medical patient ,page 767 writes (copy pasting)
"
TREATMENT OF EXACERBATIONS
Check peak flow (<50% personal best or predicted suggests severe exacerbation, as does accessory muscle use or suprasternal retractions).
Initial treatment (at home) with short-acting inhaled β-agonist (up to three treatments of two to four puffs by metered-dose inhaler every 20 minutes or a single nebulizer treatment). Assess response. Good response (mild exacerbation): peak flow greater than 80% of predicted, no wheezing or shortness of breath, response to β-agonist sustained for 4 hours. Continue β-agonist every 3 to 4 hours for 24 to 48 hours; if the patient is on inhaled steroids, double the dose for 7 to 10 days. Inform clinician. Incomplete response (moderate exacerbation): peak flow 50 to 80% of predicted, persistent wheezing and shortness of breath. Add oral corticosteroid, continue β-agonist. Contact clinician urgently. Poor response (severe exacerbation): peak flow less than 50% of predicted, marked wheezing and shortness of breath. Add oral corticosteroid, repeat β-agonist immediately. Proceed to emergency room. If distress is severe, consider calling 911. In the Emergency Room: oxygen, inhaled short-acting β-agonists, consider anticholinergics (ipratropium), intravenous or oral corticosteroids. Impending respiratory failure: signs of declining mental clarity, worsening fatigue, and a Pco2 greater than 42 mmHg, may require intubation. Trials of intravenous magnesium sulfate and mixtures of helium and oxygen (heliox) have shown benefit in a limited number of studies. " You will see he does not mention theophyllin
Under the heading of "Asthma in adults and adolescents " page 921 "Conn's Current therapy 2006" groups antiasthmatic drugs into two categories ,
He puts the methylxanthines unders controllers not relievers.
Best of luck
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