Aminophylline Use in Pediatric Patients with Acute Severe Asthma

Indications and Administration

The American Thoracic Society recommends aminophylline as a second-line therapy for pediatric patients with acute severe asthma that does not respond to initial treatment with oxygen, corticosteroids, and nebulized bronchodilators 1
Aminophylline is indicated for pediatric patients with further deterioration despite initial treatment with high-flow oxygen, nebulized bronchodilators, and systemic corticosteroids 2, 3, 4
It should be considered when patients exhibit life-threatening features such as cyanosis or silent chest, poor respiratory effort, fatigue or exhaustion, agitation or reduced level of consciousness, or peak expiratory flow (PEF) <33% predicted 3, 4, 5

A loading dose of 5 mg/kg administered intravenously over 20 minutes is recommended, followed by a maintenance dose of 1 mg/kg/hour as continuous infusion 2, 3, 4
The loading dose should be omitted if the child is already receiving oral theophyllines 2, 3, 4

First-line treatment for acute asthma in children includes high-flow humidified oxygen, nebulized bronchodilators, and systemic corticosteroids 2, 3, 4
Aminophylline should be considered when the patient shows deterioration or inadequate response to first-line treatment, or when life-threatening features are present 2, 3, 4, 6
Contraindications and cautions include patients already receiving oral theophyllines, and age under one year, which requires careful dosing and monitoring 2, 3, 4, 5