Background: Aminophylline may have a role in the management of COPD ( both stable and exacerbating ) but its use remains controversial, due to its narrow therapeutic window. We tried to position aminophylline in the management of acute exacerbations of COPD (AECOPD )

Methods: We enrolled 25 patients admitted with AECOPD with persistent hypoxia and hypercarbia despite 48 hours of standard therapy, including non-invasive ventilation. They were matched with a historical cohort of patients who had not received aminophylline. A slow loading infusion of aminophylline (6 mg/kg) was administered, followed by a maintenance dose of 0.5 mg per kg over 24 hours under monitored conditions. We assessed the length of stay in the hospital as the primary outcome. Our null hypothesis was that there was no difference in length of hospital stay in patients who received aminophylline when compared with historical controls.

Results: The study did not meet its primary end point. However, there was a significant improvement in oxygenation (P/F ratio) and decrease in PaCO2 levels 48 hours after completion of aminophylline treatment. Other secondary endpoints, like MRC dyspnoea score and ICU length of stay, did not show significant improvement. Adverse events, including nausea and tachycardia, were reported in the study group, but as per pre-defined criteria, none of them required termination of the infusion. There was no significant difference in baseline parameters like pH, oxygenation, or PaCO2 levels between the matched groups.

Conclusion: Though aminophylline infusion did not significantly impact the length of hospital stay, it improved oxygenation and reduced PaCO2 levels in AECOPD patients.No significant adverse events were noted.