Abstract
Background: Intravenous aminophylline (IVA) is sometimes used in the treatment of pulmonary exacerbations of cystic fibrosis (CF), however there is limited evidence for its benefit and small scale data suggest higher dosing may be needed for therapeutic effects (Isles et al 1983). We aimed to assess the safety, tolerability and efficacy of IVA in our large adult CF centre.
Methods: Retrospective pilot study of consecutive patient admissions receiving IVA over 5 months (Oct 2013-Feb 2014) including assessment of dose prescribed, serum levels, and side effects; with an observational subgroup analysis of efficacy (spirometry pre/post IVA and sputum clearance) in 15 patients prospectively.
Results: 30 patients received IVA. Median (range) duration of treatment was 8 (3-16) days. All infusions commenced at ≥0.5mg/kg/hour. Of 240 serum levels: 59.6% were sub therapeutic, 40% therapeutic (10-20mg/L) and 0.4% high. Side effects were common (60%) but did not lead to drug cessation (n=0).
% Predicted FEV1 and FVC improved from median (range) 33 (17-52) to 41 (22-63) and 49 (20-85) to 69 (29-108), respectively. Median change in % predicted of FEV1 7.5 (0-16) and FVC 12.5 (0-59). Improved sputum clearance was reported in 67% (n=10) of patients. 80% (n=12) of patients had therapeutic levels, not clearly linked to sputum clearance or improved spirometry.
Conclusion: High doses are required to achieve therapeutic levels in most patients although toxicity is extremely rare. Side effects are common but tolerance to these is high. Efficacy data suggests potential benefit with IVA regardless of serum levels; this now needs to be tested in a prospective controlled study.
- © 2014 ERS
