소아의 급성 천식발작에서 아미노필린의 효능과 안전성에 대한 재조명
Re-evaluation of the Efficacy and Safety of Aminophylline for Children with Acute Asthma Exacerbation
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목 적 : 메틸잔틴은 흡입된 β2-항진제처럼 기관지 확장 효과가 있으나, 부작용에 대한 염려 때문에 GINA에 따르면 메틸잔틴은 대체치료로만 사용할 것을 권장한다. 하지만 이와는 다르게 일본 소아천식 치료 및 관리 가이드라인(JPGTMA 2005)에 의하면 전신적 부신피질호르몬과 함께 사용하는 것을 권장하고 있다. 본 연구는 부신피질호르몬과 흡입성 β2-항진제에 아미노필린의 추가 투여가 큰 부작용이 없이 천식증상을 더 빠르고 더 잘 완화시키는지를 알아보고자 하였다. 방 법 : 37명의 급성 천식발작을 보인 환아들을 대상으로 하였고, 20명의 환자들(A군)은 전신적 부신피질호르몬과 흡입성 β2-항진제에 아미노필린을 추가로 정주하였고, 나머지 17명(B군)은 전신적 부신피질호르몬과 흡입성 β2-항진제만으로 치료받았다. 치료 전후의 천명의 정도, 흉부함몰, 기좌호흡, 그리고 SpO2를 포함하는 증상점수를 평가하였다. 결 과 : A군 환아들은 B군에 비해서 천식 증상점수가 빠른 호전을 보였으며,(P<0.05) 천명이 의미있게 감소하는 것을 알 수 있었다.(Logrank test P<0.05) B군에서 72시간 이상 천명을 보이는 환자들은 72시간 이내로 천명을 보인 환아들에 비해 더 많은 전신적 부신피질호르몬을 투여받았다.(P<0.05) 아미노필린의 부작용은 A군의 20%에서 나타났지만, 모두 심각한 경우가 아니었고, 약의 투여를 중단할 정도도 아니었다. 결 론 : 아미노필린은 급성 천식발작이 있는 우리나라 천식소아에게 좋은 치료선택이 되겠다. 이러한 결론을 뒷받침하기 위해서는 더 많은 연구가 지속되어야 하겠다.
Abstract
Purpose : Although methylxanthines (aminophylline or theophylline) have an equivalent bronchodilator effect on inhaled β2-agonists, the GINA guidelines recommend methylxanthines as an alternative to methylxanthines becamse of their side effects. The Japanese Pediatric Guidelines for the Treatment and Management of Asthma (JPGTMA 2005), however, recommends methylxanthines for the treatment of asthma attack along with systemic corticosteroids. We aimed to determine whether the addition of intravenous (IV) aminophylline with both IV corticosteroids and inhaled β2-agonists would improve asthma symptoms better and earlier without serious adverse effects. Methods : Thirty-seven children with acute asthma exacerbation were studied. Twenty patients were treated with a combination of IV corticosteroids, inhaled β2 agonists and IV aminophyllines (Group A), and 17 patients were treated with IV corticosteroids and inhaled β2 agonists only (Group B). We evaluated the changes of symptom scores, including degrees of wheezing, retraction, orthopnea, cyanosis and SpO2, before and after treatment in both groups. Results : Group A patients showed faster improvement in asthma symptom score (P<0.05) and significantly faster resolution of wheezing (P<0.05) than Group B patients. In Group B, patients with prolonged wheezing (>72 hours) resulted in need for larger dose of systemic steroids (P<0.05). Although adverse effects occurred in 20% of Group A patients, all of which them were not serious without the need for drug withdrawal. Conclusion : IV aminophylline may be a therapeutic option for children with acute asthma exacerbation. Further evidence is needed to substantiate the conclusion.
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