Effect of aminophylline when added to metaproterenol sulfate and beclomethasone dipropionate aerosol

Twenty-one patients with frequently recurrent severe asthma were treated for 2 wk with placebo capsules and metaproterenol sulfate aerosol therapy followed by beclomethasone dipropionate aerosol therapy sequentially inhaled every 4 to 6 hr and for 2 wk with the same aerosols and aminophylline therapy added. Treatment was double-blind, and the therapy regimens were administered in a random sequence. Patients measured their PEFR at home before and after aerosol, inhalation three times a day. The mean PEFRs before inhalation of aerosol were significantly higher when patients were receiving aminophylline therapy. In 86% of the patients, the mean PEFR that was measured after inhalation of metaproterenol sulfate was 11% greater when they were also receiving aminophylline therapy, but this difference was not significant. In 14% of the patients, however, postaerosol inhalation PEFRs were significantly higher (50% to 80%) after aminophylline therapy was added to aerosol therapy. PEFRs were always lowest in the early morning, regardless of the therapy administered. Therapy regimens that contained aminophylline were associated with less dyspnea but produced more adverse side effects and were more costly. Thus in most patients the favorable effect that aminophylline therapy produced by raising baseline PEFRs and attenuating dyspnea should be balanced against the adverse effects this medication also produced, since in most patients aminophylline therapy did not significantly enhance postinhalation PEFRs.