Analysis of serum concentration of aminophylline for treating asthma in pediatrics
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Objective: To observe the correlation between the serum concentration of aminophylline and the clinical effect on pediatric patients with asthma, and to study the factors that affect the serum concentration of aminophylline. Meth ods: The data of 43 pediatric patients with asthma whose serum concentration of aminophylline were determined were assessed retrospectively. Results: The averag e serum concentration of aminophylline was 12.89±5.19 mg/L. 86.0% of the cases had the effective serum concentration of aminophylline (5~20 mg/L). None exceede d 20 mg/L. Combined-usage of drugs always effect the serum concentration of amin ophylline. Conclusions: There is great individual difference in the serum concen tration of aminophylline. It is important to monitor the serum concentration of aminophylline in order to assure the clinical effect.Keywords:
Aminophylline
Serum concentration
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Aminophylline
Crossover study
Vital capacity
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This study allowed to investigate the effect of theophylline (Theo-Dur Astra) given 1 tablet á 200 mg per day in the evening for six weeks on histamine-induced airways responsiveness++ (PC20H), spirometric parameters and the concentration of soluble interleukin 2 receptor (sIL-2R) in serum. 21 patients with mild asthma (6 women, 15 men), average age 34.8 +/- 11.4 years were qualified for this study. PC20H was estimated according to Cockroft's method using pneumatic inhalator (Voyage-Secura Nova). Concentration of sIL-2R in serum was measured by Predicta Interleukin 2 Receptor Kit (Genzyme). Lung function test was measured by means of ABC PNEUMO (abc MED). Six week treatment with theophylline significantly increased PC20H in comparison with basal results (0.74 +/- 0.68 mg/ml before and 0.89 +/- 0.71 mg/ml after p < 0.04). The concentration of sIL-2R in serum did not change significantly during theophylline therapy. Treatment with theophylline significantly increased FEV1 (3.64 l/sec before and 3.84 l/sec after p < 0.001). The anti-inflammatory effect of theophilline is more clearly shown in the decrease of histamine-inducted airways responsiveness than in the decreased concentration of sIL-2R in serum.
Basal (medicine)
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Bronchodilatation
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Terbutaline
Acute severe asthma
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This study was designed to investigate the effect of sustained-release theophylline therapy on serum pyridoxal concentration in children with bronchial asthma. Forty-two children with bronchial asthma were divided into two groups according to duration of theophylline administration: The 22 children in group A had been treated with theophylline for less than 4 weeks, whereas the 20 children in group B had been treated for more than 5 weeks. The results obtained from this study were as follows: 1) The serum pyridoxal concentration in group B was significantly lower than that those in group A (p < 0.01). 2) The serum pyridoxal concentration was not significantly correlated with the serum theophylline concentration. These findings suggest that long-term theophylline therapy can depress vitamin B6 status in children with bronchial asthma. Theophylline-induced seizure may be caused by the possible decreased in gamma-aminobutyric acid concentration in the brain as a result of decrease in gamma-aminobutyric acid concentration in the brain as a result of decrease in vitamin B6 status, even if the serum theophylline concentrations are within the therapeutic range.
Serum concentration
Therapeutic index
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The authors investigated whether theophylline metabolism is decreased in asthmatic patients and what condition may be related to its reduction. Fifty‐two children with asthma were given 15 mg/kg/day aminophylline intravenously at a constant rate. Blood and spot urine samples were collected at 24 hours, 48 hours, and 72 hours after beginning infusion. The ratio of plasma theophylline concentration at 72 hours to that at 24 hours (C72h/C24h) varied from 0.42 to 1.51 (average 0.894). Plasma theophylline concentration of patients with lower C72h/C24h than average reduced significantly, while the concentration of those with higher C72h/C24h remained unchanged. The urinary ratio of the sum of the metabolites to theophylline was significantly increased in the patients with the lower ratio. Among the demographic characteristics examined, significant difference was found only in the incidence of patients with C‐reactive protein (CRP) of 0.5 mg/dl or greater or patients with a fever of 37.5°C or greater when admitted. Acute febrile illness accompanied by increased CRP level may affect theophylline metabolism.
Aminophylline
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Asthma Exacerbations
Bronchodilator Agents
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In 9 "stable" adult asthmatics, the relationship between serum theophylline level and pulmonary function, as well as the interaction of aminophylline and inhaled beta2-agonist on pulmonary function, were studied. At varying levels of serum theophylline between 6 and 25 micrograms/ml, which were brought about by increasing oral doses of a slow-release theophylline preparation, the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), airway resistance (Raw), and lung volume were assessed before and after inhalation of a B2-sympathicomimetic (isoetharine). In those subjects in whom it was possible to obtain blood levels within all 3 ranges of less than 10, 11 to 15, and greater than 15 micrograms/ml, there was a significant (p less than 0.05) increase in FEV1 between a mean level of 6.4 +/- 0.9 micrograms/ml and one of 12.8 +/- 0.2 micrograms/ml, but there was no further significant improvement at a mean value of 19.2 micrograms/ml +/- micrograms/ml. Specific airways conductance (SGaw) showed no change at increasing serum theophylline levels. In addition, inhaled beta-agonist increased FEV1 and SGaw maximally at all times, irrespective of the serum theophylline level, and there was no relationship between the response to inhaled bronchodilator and the serum theophylline level. The data indicate that unlike the patient in serious difficulty, ventilatory function was not improved by maximizing serum theophylline levels in this population of stable asthmatics. This suggests that theophylline may be less useful for the stable asthmatic patient than for the acutely ill patient.
BETA (programming language)
Adrenergic beta-Agonists
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This study was undertaken to investigate the effect of theophylline on circulating vitamin B6 levels in children with asthma. Twenty-six asthmatic children, including 20 patients who were treated with slow-release theophylline and 6 patients not receiving any type of theophylline preparation, were enrolled in this study. Steady state serum theophylline and vitamin B6 [pyridoxal 5'-phosphate (PLP) and pyridoxal (PL)] levels were evaluated in these patients. A depression of serum PLP levels existed in asthmatic children treated with theophylline compared to those not receiving theophylline (5.3 +/- 0.5 vs. 9.0 +/- 1.4 ng/ml, mean +/- SEM; p < 0.05). A significant negative correlation between the serum levels of PLP and theophylline was demonstrated in the subjects of this study (rs = -0.609, p < 0.001). Oral administration of 200 mg of theophylline (TheoDur) to 5 children with asthma significantly depressed serum PLP levels 4 h after the drug intake (p < 0.05), whereas theophylline did not affect serum PL levels. From these results, we conclude that theophylline induces a depression of circulating PLP levels in asthmatic children.
Vitamin b
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The authors have examined the compliance of asthmatic patients receiving slow-release aminophylline and the relationship between the serum theophylline concentrations and lung function. The effect of meals on the serum concentrations of theophylline was also studied. Twenty-nine patients were analyzed. When the serum drug concentration was measured in a blood sample obtained without prior announcement, 79% of patients were found to have the concentration of theophylline lower than the therapeutic one. When the concentration was measured in a blood sample obtained announced, 55% of patients had therapeutic concentrations. A statistically significant difference (P less than 0.01) in the concentrations of theophylline between the blood samples obtained unannounced and announced was found. There was no correlation between the concentrations of theophylline and PEFR neither in the blood sample obtained unannounced (r = -0.11) nor in that obtained announced (r = 0.09). The theophylline concentrations were higher when the drug was ingested before the meal (means 1 = 70 mumol/L), whereas they were lower when it was ingested after the meal (means 1 = 40 mumol/L). Thus, in hypodosed patients who ingest medicine after the meal, the serum theophylline concentrations might be elevated by taking therapy before the meal.
Aminophylline
Serum concentration
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