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Caffeine for obstructive lung disease 11/4/2009
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I have a patient who has end-stage COPD & refuses to use her breathing machine in acute exacerbations. She is on albuterol, & atrovent and she thinks she can rely on MDI's alone for her treatment. When her O2 sats are low and she refuses to take a breathing treatment, I try to pull everything out of my hat to help her breathe, i.e. ativan, her inhalers, make sure she is in a upright position, and has her O2 on via N/C at 2Lpm. I have also tried to find evidenced based information on the benefits of caffeine and how it may help open the airways. Is giving her a cup of coffee beneficial? I believe it is because she seems to be able to breathe much better, her sats improve, no audible respiratory distress is heard and she will go right back to bed if in the middle of the night. I have been chastised at work for giving her a cup of coffee as it is our policy and procedure to not allow patients caffeine during sleeping hours, but since she is a COPD'r and noncompliant with the pulmonade machine, I was hoping to find and deliver legitimate research to my nursing manager so an exception will be made for her. Thank you. |
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Thank you for your recent inquiry.
There is a wealth of literature regarding the effect of caffeine on pulmonary function. It is clearly a bronchodilator. The use of caffeine has been abandoned to a great extent because we now have far better drugs, but caffeine can still serve as a bronchodilator. Examples of studies that have looked at this issue are copied below for your convenience.Of course because it does have bronchodilating effects does not automatically justify it's use. Like all therapeutic agents a risk/benefit analysis and comparison with other agents determines whether it should be employed.
Thank you again for your inquiry and we hope this response is helpful to you.
Abstract 1:
(New England J Medicine 310:743, 1984)
We compared the bronchodilator effects and pharmacokinetics of orally administered caffeine (10 mg per kilogram of body weight) and theophylline (5 mg per kilogram) in a double-blind, single-dose study in asthmatic patients 8 to 18 years of age. After 48 hours of withdrawal of all methylxanthines, 13 patients received caffeine and 10 received theophylline. Significant improvements in forced vital capacity, forced expiratory volume in one second, and forced expiratory flow rates occurred from one to six hours after administration of either caffeine or theophylline. The bronchodilator effect of caffeine did not differ significantly from that of theophylline and was maximal two hours after ingestion of each drug. Peak serum levels of caffeine (13.5 +/- 2.9 mg per liter) occurred at one hour, and peak levels of theophylline (8.4 +/- 1.7 mg per liter) at 2.2 +/- 0.8 hours. The mean serum half-time for caffeine was 3.9 +/- 1.4 hours and that for theophylline was 5.8 +/- 1.7 hours. All patients receiving caffeine metabolized it to paraxanthine, theobromine, and theophylline. Mild, transient side effects were seen after both caffeine and theophylline. Vital signs did not change significantly after either drug. We conclude that caffeine, a commonly available chemical, is an effective bronchodilator in young patients with asthma.
Abstract 2:
Cochrane Database Syst Rev. 2000;(2):CD001112.
Caffeine for asthma.
Bara AI, Barley EA.
Department of Public Health Sciences, St George's Hospital Medical School, Cranmer Terrace, Tooting, London, UK, SW17 ORE. airways@sghms.ac.uk
Update in:
Cochrane Database Syst Rev. 2001;(4):CD001112.
BACKGROUND: Caffeine has a variety of pharmacological effects. It is chemically related to the drug theophylline which is used to treat asthma. Accordingly, interest has been expressed in its potential role as an asthma treatment. A number of studies have explored the effects of caffeine in asthma, this is the first review to systematically examine and summarise the evidence. OBJECTIVES: Caffeine is a weak bronchodilator and it also reduces respiratory muscle fatigue. It has been suggested that caffeine may reduce asthma symptoms. The objective of this review was to assess the effects of caffeine on lung function and identify whether there is a need to control for caffeine consumption prior to lung function testing. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register and the reference lists of articles. We also contacted study authors. SELECTION CRITERIA: Randomised trials of oral caffeine compared to placebo in adults with asthma. DATA COLLECTION AND ANALYSIS: Trial quality assessment and data extraction were done independently by two reviewers. MAIN RESULTS: Six trials involving a total of 55 people were included. The studies were all of cross-over design and of high quality. In comparison with placebo, caffeine appears to improve lung function for up to two hours after consumption. Forced expiratory volume in one minute showed a small improvement up to two hours after caffeine use (standardised mean difference -0.73, 95% confidence interval -1.20 to -0.25). Mid-expiratory flow rates also showed a small improvement with caffeine and this was sustained up to four hours. REVIEWER'S CONCLUSIONS: Caffeine appears to improve airways function modestly in people with asthma for up to four hours. People may need to avoid caffeine for at least four hours prior to lung function testing
Sincerely,
Phil Lieberman, M.D.
7205 Wolf River Boulevard, Suite 200
Germantown, TN 38138
Telephone: 901-757-6100
Fax: 901-757-6109
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