Acute theophylline intoxication. Biphasic first order elimination kinetics in a child.

An acute theophylline intoxication in a child is reported. It was characterized by two distinct first-order elimination processes with t1/2 = 12.6 hr (ke = 0.056 hr-1) and t1/2 = 5.4 hr (ke = 0.128 hr1), respectively. It is proposed that the slower process, which was seen at high plasma levels, represents renal plus saturated hepatic elimination. The later, more rapid process seen at therapeutic plasma levels is consistent with hepatic elimination by biotransformation.

Non-compliance in asthmatic children: a study of theophylline levels in a pediatric emergency room population.

Sub-therapeutic theophylline levels due to patient (parent) non-compliance is a significant cause of outpatient treatment failure in childhood asthma. In a study of 50 known asthmatic children with acute asthmatic episodes, 98% had sub-therapeutic theophylline levels less than 10 mcg/ml with 75.5% due to inadequate patient (parent) compliance.

Comparative study of extended release albuterol sulfate and long-acting inhaled salmeterol xinafoate in the treatment of nocturnal asthma.

BACKGROUND: Nocturnal worsening of asthma is a common problem in asthma and is associated with increased morbidity and mortality. Long acting beta-2 agonists are considered long-term symptom control medications, especially for nocturnal symptoms. OBJECTIVE: To compare efficacy of an extended release oral beta-2 agonist, albuterol sulfate (Volmax), to a long-acting inhaled agent, salmeterol (Serevent) in the treatment of nocturnal asthma. METHODS: This was a multicenter double-blind, double-dummy, randomized, crossover design with a 1-week baseline period and two 3-week treatment periods separated by a 7 to 9-day washout. An optional 2-week, open-label phase was conducted to evaluate patient preference. RESULTS: A total of 46 patients were included in the efficacy analysis. For the primary outcome variable of morning peak expiratory flow, there were similar and significant improvements over the 3-week treatment period for both medications compared with baseline (P < .001). Similar improvements were seen in the overnight change in PEF values (P < .001). The morning and overnight changes in FEV1 were not significantly different between treatment arms (P > .05). There were significant improvements in both treatment periods in regard to the percentage of nights without awakenings (baseline 53.6+/-5.3%), extended release albuterol 83.3+/-3.0% (P < .001), and salmeterol 88.8+/-2.4%. The percentage of patients who had no awakenings during treatment did not differ significantly for the two medications. Both treatments also resulted in a decrease in the use of rescue albuterol (extended release 2.66+/-0.35 puffs per day, salmeterol 1.85+/-0.29) from baseline (4.57+/-0.41, P < .001). There was a significant difference between groups (P = .001). The reasons why patients preferred one medication over the other varied. CONCLUSION: Both extended release albuterol tablets and inhaled salmeterol resulted in similar bronchodilation and good control of nocturnal asthma symptoms.

Cockroach allergy in Kentucky: a comparison of inner city, suburban, and rural small town populations.

The cockroach has been reported as a major allergen in inner city asthmatic patients. The retrospective chart review of 799 patients tested over a 10-year period (1981-1991) derived from a private allergy practice and a university allergy clinic is reported. Patients from both groups were divided geographically by home zip codes into inner city, suburban, or rural small town populations. Criteria for positive skin tests were wheal greater than 5 mm for prick and greater than 10 mm for intradermal tests with flare. Overall, 36.9% (295/799) of all patients surveyed were positive by either prick or intradermal skin testing. Cockroach reactivity was observed in 38.6% (95/246) of the private patients tested with 36.2% (200/553) of the university patients showing positive results. The inner city populations in both groups of patients were similar with 43.7% and 40.3% of the private and university patients, respectively, testing positive, with an overall positivity of 41% for all inner city patients. Inner city and rural small town populations for both study groups demonstrated almost identical reactivity with 41% and 43% overall positivity, respectively. Of the suburban group, 37.5% of the private patients and 28.8% of the university patients had reactive skin tests results with an overall rate of positivity of 30.1%. This rate (30.1%) is significantly less than the rate for either inner city (41.0%, P < .05) or rural small town (43.6%, P < .01) populations.(ABSTRACT TRUNCATED AT 250 WORDS)