Revista del Instituto Nacional de Enfermedades Respiratorias
Print version ISSN 0187-7585
ARELLANO MARTINEZ, Jesús and GARCIA GUILLEN, Ma. de Lourdes. Evidence for the use of methylxantines in exacerbations of COPD. Rev. Inst. Nal. Enf. Resp. Mex. [online]. 2006, vol.19, n.4, pp.309-315. ISSN 0187-7585.
Introduction: Methylxantines are used for stable chronic obstructive pulmonary disease (COPD), when there is need for an additional drug besides β2 agonists and anticholinergics, in the more advanced stages of the disease and during acute exacerbations. Among other effects, methylxantines are said to have bronchodilator properties. Objective: To review the evidence supporting the use of methylxantines during acute exacerbations of COPD , and the presence of other beneficial properties besides their bronchodilator effects. Method: Medline and EMBASE computer search for aleatorized controlled studies comparing methylxantines (oral theophylline, intravenous aminophylline or doxophylline) vs placebo. Results: Only five of 1,356 published studies fulfilled the inclusion criteria. The evidence showed no significant improvement in FEV1 only one study showed a 70 vs 40 mL improvement on day 3; there was also decrease in the PCO2 and slight increase in the pH 12 hours after the use of aminophylline. There was no significant improvement in length of stay, quality of life nor dyspnoea scales. Nausea and vomiting were more frequent in the methylxantine group. Conclusions: We need properly structured protocols with statistically significant results, to define the evidence based place for the use of methylxantines in the treatment of acute exacerbations of COPD.
Keywords : Aminophylline; doxophylline; evidence based medicine; exacerbation of COPD; methylxantines; theophylline; treatment.