Computer assisted design of a theophylline dosing regimen in acute bronchospasm: Serum concentrations and clinical outcome

Abstract

The effect of intravenous theophylline on the outcome of inhospital treatment of acute bronchospasm has been assessed, comparing the results achieved by computer-assisted dosing, designed to achieve and maintain a serum theophylline level of 16 micrograms.ml-1 (10 patients) with those of unaided physicians (15 control patients). The outcome measures compared were clinical improvement, peak expiratory flow rate and serum theophylline concentration. Loading doses of theophylline in the control and computer groups were: 167 and 437 mg, respectively. Initial serum theophylline concentrations, measured 20 min after the loading dose, were 13.6 and 17.0 micrograms.ml-1 in the control and computer groups, respectively. In patients who had not received theophylline prior to admission, loading doses and initial concentrations were: 200 mg and 9.4 micrograms.ml-1 in the control group (n = 5) versus 613 mg and 15.7 micrograms.ml-1 in the computer group (n = 4), respectively. During maintenance therapy, serum theophylline concentrations were kept in the therapeutic range (10-20 micrograms.ml-1) throughout 51% and 77% of the hospitalisation period, in the control and computer groups, respectively. There were no differences between the two groups in the rate or extent of clinical improvement or in change in peak expiratory flow rate. The computer assisted theophylline dosing regimen outperformed that of the unaided physicians in achieving and maintaining therapeutic serum theophylline concentrations in acute bronchospasm. There was no correlation between clinical outcome and serum theophylline concentration, but this may have been due to the small sample size and modest difference in serum theophylline between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer support for determining drug dose: systematic review and meta-analysis

“…8 13 14 17 19 21 24Studies on theophylline showed increases in initial dose 14 21and in maintenance dose. 13 14 Studies on intravenous anaesthesia showed a reduction in total dose of fentanyl used24 and a reduction in initial dose and maintenance dose of midazolam 19…”

“…Drug doses used —Eleven studies examined change in the drug dose when computer support was used, 8 9 11 13 14 17 – 19 21 23 24 and seven found significant changes. 8 13 14 17 19 21 24Studies on theophylline showed increases in initial dose 14 21and in maintenance dose.…”

“…Three showed significant benefits in clinical improvement scores for asthma,21 treating infection,9 and pain relief after surgery 20. Fewer caesarean sections were required when oxytocin was given by computer controlled pump to augment labour 9.…”

Computer support for determining drug dose: systematic review and meta-analysis

“…We identified 23 relevant studies, of which 16 randomised controlled clinical trials [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] and one non-randomised controlled clinical trial 24 met the inclusion criteria. All used reliable outcome measures with adequate blinding of assessment.…”

“…12 Outcome of medical care-Six studies directly measured outcomes of care, of which five showed benefits. Three showed significant benefits in clinical improvement scores for asthma, 21 treating infection, 9 and pain relief after surgery. 20 Fewer caesarean sections were required when oxytocin was given by computer controlled pump to augment labour.…”