Methylxanthine use for acute asthma in the emergency department in Japan: a multicenter observational study

Abstract

Aim Methylxanthines are no longer recommended for emergency department (ED) patients with acute asthma according to international guidelines. We aimed to describe the current methylxanthine use for acute asthma and to determine factors related to its use in the ED. Methods We undertook a multicenter retrospective study in 23 EDs across Japan. From each participating hospital, we randomly identified 60 ED patients aged 18–54 years with acute asthma from 2009 through 2011. We examined the associations of ED and patient characteristics with methylxanthine use by constructing a multivariable logistic regression model adjusting for a predefined set of ED‐ and patient‐level factors. Results Among 1,380 patients, methylxanthines were used for 79 patients (5.7%, 95% confidence interval [CI], 4.6–7.0%). The proportion of methylxanthine treatment varied substantially among EDs, ranging from 0% to 26.1%. In the multivariable analysis, the number of annual ED patients with acute asthma (odds ratio [OR] per 100 increase in annual asthma patients, 0.12; 95% CI, 0.04–0.34; P < 0.001) and having a protocol for asthma treatment (OR 2.91; 95% CI, 1.06–8.00; P = 0.04) at the ED level, and systemic corticosteroid use (OR 6.39; 95% CI, 3.34–12.22; P < 0.001) at the patient level were associated with likelihood of methylxanthine use. Conclusions In this multicenter study, approximately 6% of ED patients with acute asthma were treated with methylxanthines, with a wide variation across EDs. The number of annual ED patients with acute asthma was significantly associated with a lower likelihood of methylxanthine use, whereas having an ED asthma treatment protocol and systemic corticosteroid use in the ED were associated with a higher likelihood of methylxanthine treatment.

Challenges hindering emergency physicians; involvement in multicenter collaborative studies in Japan: A nationwide survey analysis

“…Therefore, it is vital to establish additional support structures through the collaborative efforts of multiple stakeholders to secure funding from academic societies, corporations, and government‐based clinical research support systems 8‐10,25 . Moreover, factors such as heavy workloads, frequent burnout episodes, and scant sleep among emergency physicians in Japan add to the challenge of securing adequate research time 13 . Consequently, there is a pressing need for profound reforms in the working environment.…”

“…Unlike other nations, Japan lacks the presence of Clinical Trial Groups that consistently produce multicenter clinical trial results 10 . Moreover, reports indicate a high rate of burnout among Japan's emergency physicians, potentially hampering clinical research participation 13 . Recent findings underscore the struggles of Japanese university–affiliated physicians in setting aside adequate research time 14 .…”

Life-threatening bronchial asthma in children: from predictors to prognosis

“…Терапия препаратами второй линии Аминофиллин (рекомендации с учетом альтернативных вариантов). Частота использования метилксантинов в последние годы существенно снизилась, что связано с другими эффективными моделями купирования бронхообструкции и побочным действием данных препаратов [46]. Более того, использование аминофиллина увеличивает среднюю длительность пребывания детей с астматическим статусом в отделении реанимации и интенсивной терапии и положительный эффект достижим только при добавлении этого препарата к основной тера-пии в течение первых 6 ч [47].…”

Coronavirus disease 2019 and the natural agents

“…Recent reports stated that methylxanthines have protective effects on the respiratory system and are beneficial in airway diseases with growing prevalence in children, especially asthma and cough. [ 27 ] In addition, theobromine was reported to have positive inotropic effect on the heart and produce vasodilatation of the blood vessels, thereby decreasing the blood pressure. [ 28 ] Theophylline, which is one of the constituents of the green tea, has been used for years in treating asthma and is still among the most prescribed medications due to its bronchodilator and anti-inflammatory properties.…”