human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Our investigation supports the use of intravenous salbutamol as an alternative to aminophylline in the early stages of acute severe asthma .  Salbutamol proved to be a marginally better bronchodilator and is likely to cause less gastrointestinal side effects than aminophylline , but tachycardia and generalized tremor are more frequent with this drug The role of bronchodilator regimens combining a sympathomimetic and a methylxanthine in the treatment of acute exacerbations of asthma remains controversial . This report describes the outcome of 157 emergency room visits for asthma in which patients were r and omly assigned to single-drug therapy with intravenous aminophylline , subcutaneous epinephrine , or inhaled isoproterenol or to one of three regimens combining a sympathomimetic and a methylxanthine . The increase in one-second forced expiratory volume after one hour of treatment with the two-drug combinations ( 0.79 + /- 0.07 liter ) was significantly greater than for epinephrine alone ( 0.57 + /- 0.08 liter ; p less than 0.05 ) but did not differ significantly from that occurring with therapy with isoproterenol alone ( 0.72 + /- 0.09 liter ; p = NS ) . This disparity reflects the greater bronchodilation effected by isoproterenol as a single agent than by epinephrine , in the dosing schedules and routes of administration chosen . Among patients presenting with severe airflow obstruction ( one-second forced expiratory volume 35 percent or less of normal ) , the bronchodilator response to isoproterenol alone was 0.88 + /- 0.14 liter versus 0.51 + /- 0.11 for epinephrine alone ( p less than 0.05 ) . It is concluded that the observed benefit derived from use of combination therapy depends on the dosage and potency of the particular sympathomimetic to which a methylxanthine is added , and on the severity of the airflow obstruction at presentation In patients with acute exacerbations of asthma , the intravenous administration of bronchodilators , such as salbutamol , entails the potential risk of worsening pulmonary gas exchange , despite an amelioration of airflow obstruction . The present study was design ed to investigate the effect of intravenous aminophylline on pulmonary gas exchange in patients hospitalized with a severe exacerbation of asthma . We studied 12 patients ( aged 41 + /- 13 yrs ) admitted to the hospital because of an exacerbation of asthma . The study was of a r and omized , double-blind , placebo-controlled design . Six patients were treated with intravenous aminophylline and six received placebo , in addition to st and ard treatment with inhaled salbutamol and intravenous corticosteroids .  Forced spirometry , respiratory gas exchange , ventilation-perfusion relationships assessed with the multiple inert gas elimination technique , and systemic haemodynamics were measured at baseline and 60 min after treatment started . In the aminophylline-treated group , mean theophylline plasma levels increased to 15.2 + /- 3.6 micrograms.ml-1 , forced expiratory volume ( FEV1 ) increased by 17 + /- 12 % , and forced vital capacity ( FVC ) by 16 + /- 10 % . The mean changes in FEV1 and FVC in the aminophylline-treated group were significantly higher than in the placebo-treated group . Likewise , minute ventilation increased by 23 + /- 14 % and arterial carbon dioxide tension ( PaCO2 ) decreased by 0.4 + /- 0.3 kPa ( 3 + /- 2 mmHg ) during aminophylline infusion . No significant changes in arterial oxygen tension ( PaO2 ) or in ventilation-perfusion distributions were shown in aminophylline-treated patients . ( ABSTRACT TRUNCATED AT 250 WORDS Twenty-one patients admitted to hospital with acute severe asthma were allocated in a r and om , single-blind manner to receive intravenous infusions for 24 hours or either aminophylline or salbutamol or a combination of the two drugs . Infusions were administered by a slow infusion pump with an initial loading dose given over 15 minutes , followed by a continuous lower dose of the drug 24 hours as follows : 1 . Aminophylline 0.285 mg/kg/min for 15 min followed by 0.014 mg/kg/min ( 20 mg/min . followed by 1 mg/min for a 70 kg subject ) . 2 . Salbutamol 0.285 microgram/kg/min for 15 min followed by 0.057 microgram/kg/min ( 20 microgram/min followed by 4 microgram/min for a 70 kg subject ) . 3 . Combined regimen of the above infusions . In addition each patient received intravenous hydrocortisone ( 4 g ) and potassium chloride ( 4 g ) in 2 litres of 5 % dextrose infused over 24 hours amd 35 % oxygen given via a Ventimask . Peak expiratory flow rates showed a significant improvement after 15 minutes treatment with aminophylline and the combined infusion , but this was not seen until 60 minutes with the salbutamol infusion . No synergistic bronchodilator effect was seen with the combined infusion . The results show that intravenous aminophylline is superior to intravenous salbutamol in the doses given in the initial treatment of acute asthma and that the combination when given intravenously is not better than aminophylline alone BACKGROUND The purpose of this study was to test the contribution of aminophylline in improving peak expiratory flow rate ( PEFR ) during emergency department treatment of acute asthma when metaproterenol sulfate and steroid therapy are also provided . METHODS In a prospect i ve , r and omized , double-blind , and placebo-controlled trial at a municipal hospital emergency department , 44 patients with acute asthma , aged 18 to 45 years , with theophylline levels below 28 mumol/L , who had failed to achieve a PEFR of 40 % predicted after one nebulized metaproterenol treatment , were recruited . An aminophylline or placebo loading dose and maintenance infusion were administered . All patients received hourly nebulized metaproterenol and initial methylprednisolone sodium succinate . The PEFR was measured hourly for 5 hours . Two-factor repeated- measures analysis of variance of improvement in PEFR ( [ final-initial PEFR]/predicted PEFR ) was assessed . RESULTS There was no difference in improvement of PEFR at any hour between the treatment and placebo groups . After 5 hours , the difference in improvement ratio was 0.40 ( aminophylline ) vs 0.36 ( placebo ) ( P = .30 ; n = 22 in each group ) . The treatment group suffered more tremor , nausea or vomiting , and palpitations ( P < .05 ) . CONCLUSION In the emergency department setting , aminophylline contributes no significant improvement in PEFR when beta 2-agonists and corticosteroids are being provided , while causing more side effects Thirty‐nine patients with asthma requiring acute treatment were included in a r and omized , double‐blind , paralle1 study which compared the effect of enprofylline ( 1.0 mg/kg ) and theophylline ( 3.0 mg/kg ) . The drugs were given intravenously over a period of 10 min . Peak flow ( PEF ) , heart rate and plasma concentrations of the drugs were determined before and after the injection . Both enprofylline and theophylline significantly increased the PEF 30 min after the injection , the mean increases over the baseline values being 21 % and 23 % , respectively . The clinical effects assessed by the patient and the physician and the significant decreases in heart rate were similar for the two drugs . Side effects were rare . Thus , 1.0 mg/kg of enprofylline was comparable to 3.0 mg/kg of theophylline in the treatment of patients with acute asthma Severe asthma is the most common respiratory emergency treated in casualty departments of most hospitals . Intravenous aminophylline has been the mainstay of bronchodilator treatment for several years , although sudden death may occur after rapid administration,1 2 and it may be cardiotoxic.3 We thought that a selective adrenoceptor agonist might therefore be worthy of trial , and we report here our results with single and double-blind comparative trials of intravenous aminophylline and salbutamol on 50 patients with severe asthma Thirty-seven patients with severe asthma were r and omized into three groups and treated double-blindly with either aminophylline , epinephrine , or a combination of these two for one hour and then with both drugs for an additional hour . All patients began with plasma theophylline levels less than 10 µg/ml and all achieved 17 µg/ml . Epinephrine produced 134 % improvement in FEV1 in one hour compared to 38 % improvement produced by aminophylline . Epinephrine and combination therapy produced the same amount of bronchodilatation in one hour . Patients whose initial PEFR was ≦100 l/min failed to improve with aminophylline alone . After two hours of treatment , there was no difference in FEV1 or PEFR among the three groups . Arrhythmias and vomiting occurred more frequently when aminophylline was used and these adverse responses did not correlate with plasma theophylline levels Second Department of Medicine , Teikyo University School of Medicine , * Clinical Research Center for Allergy and Rheumatology . National Sagamihara Ho.spital . f Section of Allergy and Respiratory Medicine . Doai Memorial Hospital IMat.sunwra Clinic and Research institute for Asthma and Imtnunological Diseases , l^Fourth Department of Medicine , Nippon Medical School , and ^International Medical Center of Japan , Tokyo , STUDY OBJECTIVE To determine the efficacy of intravenous aminophylline in the treatment of adult patients hospitalized for exacerbation of asthma . DESIGN R and omized , double-blind , placebo-controlled trial throughout the study . SETTING University Hospital Clinical Research Center . PATIENTS Forty-four patients admitted from the emergency room with a primary diagnosis asthma ; 39 patients completed the study . INTERVENTIONS Patients received either intravenous aminophylline or placebo in addition to frequent nebulized albuterol ; prednisone 0.5 mg/kg body weight every 6 h orally ; and supplemental oxygen . Aminophylline infusion rates were adjusted to achieve serum theophylline concentrations of 10 to 20 micrograms/ml . Changes were made in placebo infusion rates to maintain the double blind design . MEASUREMENTS AND RESULTS Forced expiratory volume in 1 s ( FEV1 ) and other spirometric measurements every 8 h by a blinded investigator or trained respiratory therapist . Subjective patient response and duration of hospitalization were compared . No difference in spirometric measurements was observed between the two groups at any time point . On admission to the study , FEV1 in the placebo group was 41.5 ( + /- 2.9 ) percent predicted and in the aminophylline group 34.7 ( + /- 2.3 ) percent predicted ( p = 0.08 ) . At discharge , FEV1 was 70.4 ( + /- 2.9 ) percent predicted in the placebo group and 63.7 ( + /- 2.8 ) percent predicted in the theophylline group ( p = 0.10 ) . There was no difference in subjective patient rating or duration of hospitalization between the two groups ( placebo 1.95 days and aminophylline 1.78 days , p = 0.51 ) . CONCLUSIONS Our results suggest that aminophylline therapy does not add significant benefit to other st and ard therapies in hospitalized adult asthmatic patients . Because of the risks and cost of aminophylline treatment in the hospital setting , further research is needed to determine if there are subgroups of adult asthmatics who may benefit from the addition of aminophylline to other st and ard optimal therapies Forty-eight patients who presented with acute episodes of asthma were r and omized to treatment with subcutaneously administered epinephrine , inhaled isoproterenol , or intravenously administered aminophylline . The patients ' couses were followed clinical ly and with spirometry . Although there were no significant differences between the groups before treatment for any measured variable , at the end of 1 hour , the mean improvement inforced expiratory volume in one second ( FEV1 ) was significantly greater for patients treated with epinephrine ( 0.76 L ) or nebulized isoproterenol ( 0.79 L ) than for those given aminophylline ( 0.23 L ) . Similarly , the mean duration of therapy required before discharge from the emergency room was significantly longer for patients receiving aminophylline ( 5.4 h ) than for patients treated with either epinephrine ( 3.5 h ) or isisoproeternol ( 3.0 h ) . There was no significant differences between the effects of the 2 beta agonists . These results demonstrated that short-acting sympathomimtic agents produce more rapid and potent bronchodilatation in acutely ill asthmatics than that provided by intravenously administered methylxanthines , and that there are no disadvantages to using an inhaled beta agonist rather than one administered parenterally Eighty-nine patients who presented to the hospital for 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Our investigation supports the use of intravenous salbutamol as an alternative to aminophylline in the early stages of acute severe asthma .  Salbutamol proved to be a marginally better bronchodilator and is likely to cause less gastrointestinal side effects than aminophylline , but tachycardia and generalized tremor are more frequent with this drug The role of bronchodilator regimens combining a sympathomimetic and a methylxanthine in the treatment of acute exacerbations of asthma remains controversial . This report describes the outcome of 157 emergency room visits for asthma in which patients were r and omly assigned to single-drug therapy with intravenous aminophylline , subcutaneous epinephrine , or inhaled isoproterenol or to one of three regimens combining a sympathomimetic and a methylxanthine . The increase in one-second forced expiratory volume after one hour of treatment with the two-drug combinations ( 0.79 + /- 0.07 liter ) was significantly greater than for epinephrine alone ( 0.57 + /- 0.08 liter ; p less than 0.05 ) but did not differ significantly from that occurring with therapy with isoproterenol alone ( 0.72 + /- 0.09 liter ; p = NS ) . This disparity reflects the greater bronchodilation effected by isoproterenol as a single agent than by epinephrine , in the dosing schedules and routes of administration chosen . Among patients presenting with severe airflow obstruction ( one-second forced expiratory volume 35 percent or less of normal ) , the bronchodilator response to isoproterenol alone was 0.88 + /- 0.14 liter versus 0.51 + /- 0.11 for epinephrine alone ( p less than 0.05 ) . It is concluded that the observed benefit derived from use of combination therapy depends on the dosage and potency of the particular sympathomimetic to which a methylxanthine is added , and on the severity of the airflow obstruction at presentation In patients with acute exacerbations of asthma , the intravenous administration of bronchodilators , such as salbutamol , entails the potential risk of worsening pulmonary gas exchange , despite an amelioration of airflow obstruction . The present study was design ed to investigate the effect of intravenous aminophylline on pulmonary gas exchange in patients hospitalized with a severe exacerbation of asthma . We studied 12 patients ( aged 41 + /- 13 yrs ) admitted to the hospital because of an exacerbation of asthma . The study was of a r and omized , double-blind , placebo-controlled design . Six patients were treated with intravenous aminophylline and six received placebo , in addition to st and ard treatment with inhaled salbutamol and intravenous corticosteroids .  Forced spirometry , respiratory gas exchange , ventilation-perfusion relationships assessed with the multiple inert gas elimination technique , and systemic haemodynamics were measured at baseline and 60 min after treatment started . In the aminophylline-treated group , mean theophylline plasma levels increased to 15.2 + /- 3.6 micrograms.ml-1 , forced expiratory volume ( FEV1 ) increased by 17 + /- 12 % , and forced vital capacity ( FVC ) by 16 + /- 10 % . The mean changes in FEV1 and FVC in the aminophylline-treated group were significantly higher than in the placebo-treated group . Likewise , minute ventilation increased by 23 + /- 14 % and arterial carbon dioxide tension ( PaCO2 ) decreased by 0.4 + /- 0.3 kPa ( 3 + /- 2 mmHg ) during aminophylline infusion . No significant changes in arterial oxygen tension ( PaO2 ) or in ventilation-perfusion distributions were shown in aminophylline-treated patients . ( ABSTRACT TRUNCATED AT 250 WORDS Twenty-one patients admitted to hospital with acute severe asthma were allocated in a r and om , single-blind manner to receive intravenous infusions for 24 hours or either aminophylline or salbutamol or a combination of the two drugs . Infusions were administered by a slow infusion pump with an initial loading dose given over 15 minutes , followed by a continuous lower dose of the drug 24 hours as follows : 1 . Aminophylline 0.285 mg/kg/min for 15 min followed by 0.014 mg/kg/min ( 20 mg/min . followed by 1 mg/min for a 70 kg subject ) . 2 . Salbutamol 0.285 microgram/kg/min for 15 min followed by 0.057 microgram/kg/min ( 20 microgram/min followed by 4 microgram/min for a 70 kg subject ) . 3 . Combined regimen of the above infusions . In addition each patient received intravenous hydrocortisone ( 4 g ) and potassium chloride ( 4 g ) in 2 litres of 5 % dextrose infused over 24 hours amd 35 % oxygen given via a Ventimask . Peak expiratory flow rates showed a significant improvement after 15 minutes treatment with aminophylline and the combined infusion , but this was not seen until 60 minutes with the salbutamol infusion . No synergistic bronchodilator effect was seen with the combined infusion . The results show that intravenous aminophylline is superior to intravenous salbutamol in the doses given in the initial treatment of acute asthma and that the combination when given intravenously is not better than aminophylline alone BACKGROUND The purpose of this study was to test the contribution of aminophylline in improving peak expiratory flow rate ( PEFR ) during emergency department treatment of acute asthma when metaproterenol sulfate and steroid therapy are also provided . METHODS In a prospect i ve , r and omized , double-blind , and placebo-controlled trial at a municipal hospital emergency department , 44 patients with acute asthma , aged 18 to 45 years , with theophylline levels below 28 mumol/L , who had failed to achieve a PEFR of 40 % predicted after one nebulized metaproterenol treatment , were recruited . An aminophylline or placebo loading dose and maintenance infusion were administered . All patients received hourly nebulized metaproterenol and initial methylprednisolone sodium succinate . The PEFR was measured hourly for 5 hours . Two-factor repeated- measures analysis of variance of improvement in PEFR ( [ final-initial PEFR]/predicted PEFR ) was assessed . RESULTS There was no difference in improvement of PEFR at any hour between the treatment and placebo groups . After 5 hours , the difference in improvement ratio was 0.40 ( aminophylline ) vs 0.36 ( placebo ) ( P = .30 ; n = 22 in each group ) . The treatment group suffered more tremor , nausea or vomiting , and palpitations ( P < .05 ) . CONCLUSION In the emergency department setting , aminophylline contributes no significant improvement in PEFR when beta 2-agonists and corticosteroids are being provided , while causing more side effects Thirty‐nine patients with asthma requiring acute treatment were included in a r and omized , double‐blind , paralle1 study which compared the effect of enprofylline ( 1.0 mg/kg ) and theophylline ( 3.0 mg/kg ) . The drugs were given intravenously over a period of 10 min . Peak flow ( PEF ) , heart rate and plasma concentrations of the drugs were determined before and after the injection . Both enprofylline and theophylline significantly increased the PEF 30 min after the injection , the mean increases over the baseline values being 21 % and 23 % , respectively . The clinical effects assessed by the patient and the physician and the significant decreases in heart rate were similar for the two drugs . Side effects were rare . Thus , 1.0 mg/kg of enprofylline was comparable to 3.0 mg/kg of theophylline in the treatment of patients with acute asthma Severe asthma is the most common respiratory emergency treated in casualty departments of most hospitals . Intravenous aminophylline has been the mainstay of bronchodilator treatment for several years , although sudden death may occur after rapid administration,1 2 and it may be cardiotoxic.3 We thought that a selective adrenoceptor agonist might therefore be worthy of trial , and we report here our results with single and double-blind comparative trials of intravenous aminophylline and salbutamol on 50 patients with severe asthma Thirty-seven patients with severe asthma were r and omized into three groups and treated double-blindly with either aminophylline , epinephrine , or a combination of these two for one hour and then with both drugs for an additional hour . All patients began with plasma theophylline levels less than 10 µg/ml and all achieved 17 µg/ml . Epinephrine produced 134 % improvement in FEV1 in one hour compared to 38 % improvement produced by aminophylline . Epinephrine and combination therapy produced the same amount of bronchodilatation in one hour . Patients whose initial PEFR was ≦100 l/min failed to improve with aminophylline alone . After two hours of treatment , there was no difference in FEV1 or PEFR among the three groups . Arrhythmias and vomiting occurred more frequently when aminophylline was used and these adverse responses did not correlate with plasma theophylline levels Second Department of Medicine , Teikyo University School of Medicine , * Clinical Research Center for Allergy and Rheumatology . National Sagamihara Ho.spital . f Section of Allergy and Respiratory Medicine . Doai Memorial Hospital IMat.sunwra Clinic and Research institute for Asthma and Imtnunological Diseases , l^Fourth Department of Medicine , Nippon Medical School , and ^International Medical Center of Japan , Tokyo , STUDY OBJECTIVE To determine the efficacy of intravenous aminophylline in the treatment of adult patients hospitalized for exacerbation of asthma . DESIGN R and omized , double-blind , placebo-controlled trial throughout the study . SETTING University Hospital Clinical Research Center . PATIENTS Forty-four patients admitted from the emergency room with a primary diagnosis asthma ; 39 patients completed the study . INTERVENTIONS Patients received either intravenous aminophylline or placebo in addition to frequent nebulized albuterol ; prednisone 0.5 mg/kg body weight every 6 h orally ; and supplemental oxygen . Aminophylline infusion rates were adjusted to achieve serum theophylline concentrations of 10 to 20 micrograms/ml . Changes were made in placebo infusion rates to maintain the double blind design . MEASUREMENTS AND RESULTS Forced expiratory volume in 1 s ( FEV1 ) and other spirometric measurements every 8 h by a blinded investigator or trained respiratory therapist . Subjective patient response and duration of hospitalization were compared . No difference in spirometric measurements was observed between the two groups at any time point . On admission to the study , FEV1 in the placebo group was 41.5 ( + /- 2.9 ) percent predicted and in the aminophylline group 34.7 ( + /- 2.3 ) percent predicted ( p = 0.08 ) . At discharge , FEV1 was 70.4 ( + /- 2.9 ) percent predicted in the placebo group and 63.7 ( + /- 2.8 ) percent predicted in the theophylline group ( p = 0.10 ) . There was no difference in subjective patient rating or duration of hospitalization between the two groups ( placebo 1.95 days and aminophylline 1.78 days , p = 0.51 ) . CONCLUSIONS Our results suggest that aminophylline therapy does not add significant benefit to other st and ard therapies in hospitalized adult asthmatic patients . Because of the risks and cost of aminophylline treatment in the hospital setting , further research is needed to determine if there are subgroups of adult asthmatics who may benefit from the addition of aminophylline to other st and ard optimal therapies Forty-eight patients who presented with acute episodes of asthma were r and omized to treatment with subcutaneously administered epinephrine , inhaled isoproterenol , or intravenously administered aminophylline . The patients ' couses were followed clinical ly and with spirometry . Although there were no significant differences between the groups before treatment for any measured variable , at the end of 1 hour , the mean improvement inforced expiratory volume in one second ( FEV1 ) was significantly greater for patients treated with epinephrine ( 0.76 L ) or nebulized isoproterenol ( 0.79 L ) than for those given aminophylline ( 0.23 L ) . Similarly , the mean duration of therapy required before discharge from the emergency room was significantly longer for patients receiving aminophylline ( 5.4 h ) than for patients treated with either epinephrine ( 3.5 h ) or isisoproeternol ( 3.0 h ) . There was no significant differences between the effects of the 2 beta agonists . These results demonstrated that short-acting sympathomimtic agents produce more rapid and potent bronchodilatation in acutely ill asthmatics than that provided by intravenously administered methylxanthines , and that there are no disadvantages to using an inhaled beta agonist rather than one administered parenterally Eighty-nine patients who presented to the hospital for 
    Output:
    