On Doctoring MEDLINE searches, with reference librarian comments, March 2000

The question was

what are the side effects of the asthma drug theophylline?

1     *Theophylline/ae [Adverse Effects]    results=96   
2     limit 1 to review articles    results= 12   

Reference Librarian comments

Your search is fine and dandy. Thanks for participating in the assignment. I have one bit of advice, which is to almost always "explode" the subject term.

When we reference librarians hear the phrase "side effects," we frequently check more than the "adverse effects" check-box. We check poisoning, toxicity, contraindications, etc. There are subtle differences in these terms, usually a little too subtle for our needs.

I tried the search "my way," and I thought I'd show you my strategy, and results, below. For this search, I think it's entirely appropriate to look at "review articles." If one needed a more comprehensive and fully up-to-date approach, one would not do that. My set #2 "limits" are rather TOO limiting, don't you think? I got overly handy with all the check-boxes.

Medline 1991 to January 2000

#
Search History
Results
1
exp *Theophylline/ae,po,to,ct [Adverse Effects, Poisoning, Toxicity, Contraindications]
252
2
limit 1 to (local holdings and human and english language and review articles)
9

<1>
AN 96385699
AU Minton NA. Henry JA.
IN Medical Toxicology Unit, Guy's Hospital, London, UK.
TI Acute and chronic human toxicity of theophylline. [Review]
[177 refs]
SO Human & Experimental Toxicology. 15(6):471-81, 1996 Jun.
LM Dana. Incomplete holdings, check catalog.

<2>
AN 97010784
AU Minton NA. Henry JA.
IN Poisons Unit, Guy's Hospital, London, U.K.
TI Treatment of theophylline overdose [see comments]. [Review]
[143 refs]
CM Comment in: Am J Emerg Med 1997 Sep;15(5):547
SO American Journal of Emergency Medicine. 14(6):606-12, 1996 Oct.
LM Pre-1993 Dana; 1993-date MFHSL (Incomplete, check catalog)

<3>
AN 97019304
AU Shechter P. Berkenstat H. Segal E. Rapoport J.
IN Department of Nephrology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
TI Theophylline intoxication: clinical features and
pharmacokinetics during treatment with charcoal hemoperfusion. [Review] [18
refs]
SO Israel Journal of Medical Sciences. 32(9):766-70, 1996 Sep.
LM Dana. Incomplete holdings, check catalog.
AB We describe a 50-year-old depressive patient with severe
theophylline toxicity that occurred as a result of attempted
suicide. Her theophylline levels peaked at 148 mg/l. She was
promptly treated with charcoal hemoperfusion, and responded well. We describe
the pharmacokinetics of theophylline removal via
hemoperfusion, and review the literature. [References: 18]

<4>
AN 95276442
AU Shields MD. Hicks EM. Macgregor DF. Richey S.
IN Royal Belfast Hospital for Sick Children, Northern Ireland.
TI Infantile spasms associated with theophylline toxicity.
[Review] [11 refs]
SO Acta Paediatrica. 84(2):215-7, 1995 Feb.
LM Matthews-Fuller Health Sciences Library (MFHSL).
AB We report on a 6-month-old infant with asthma who developed spasms and
hypsarrhythmia on the electroencephalogram (EEG) shortly after starting oral
theophylline medication. Theophylline
levels at that time were just above the upper normal range. The spasms
stopped and the EEG normalized when theophylline was
discontinued and nitrazepam therapy started. On follow-up over the next 3
years there was no recurrence of seizures and the child's neurodevelopment
has been normal. Nitrazepam was stopped at 10 months and the waking and
sleeping EEG were normal at 14 months. We believe that the infantile spasms
were caused by theophylline. [References: 11]

<5>
AN 94203141
AU O'Donnell J.
TI Theophylline misadventures: Part II. [Review] [79 refs]
SO Neonatal Network. 13(3):19-28, 1994 Apr.
LM MFHSL. Incomplete holdings, check catalog.
AB Except for overdose ingestions, excessive theophylline
serum concentrations can be attributed predominantly to therapeutic
misadventure. Utilizing medico-legal case reports as a core, this article
considers how theophylline toxicity is manifested in several
major organ systems and discusses drug/disease interactions with
theophylline that may alter serum
theophylline concentrations, necessitating dose adjustments.
Theophylline overdose is associated with significant
morbidity and mortality risks. Overdose treatment, based on use of serum
concentrations, is addressed. An understanding of all these factors can help
caregivers avoid theophylline morbidity and mortality in
neonatal patients. [References: 79]

<6>
AN 94187684
AU O'Donnell J.
TI Theophylline misadventures: Part I. [Review] [87 refs]
SO Neonatal Network. 13(2):35-43, 1994 Mar.
LM MFHSL. Incomplete holdings, check catalog.
AB Theophylline intoxication has become an important clinical
problem in the NICU, in large part because of its increased and extensive use
for treatment of neonatal respiratory diseases. This article reviews the
mechanisms of action involved in current methylxanthine uses, outlines the
range of dosage recommendations and target plasma levels in the neonate,
describes reported toxicities as extensions of the pharmacologic effects,
summarizes some recent litigation reports addressing
theophylline toxicity, and shares recommendations from
practitioners who have written about the clinical use of this class over the
past 50 years. By using suitable initial dosing guidelines and aggressive
early serum concentration monitoring, practitioners can use
theophylline safely and effectively in neonates.
[References: 87]

<7>
AN 92072815
AU Stegeman CA. Jordans JG.
IN Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The
Netherlands.
TI Theophylline intoxication, clinical features, treatment and
outcome: a case report and a review of the literature. [Review] [74 refs]
SO Netherlands Journal of Medicine. 39(1-2):115-25, 1991 Aug.
LM Dana. Incomplete holdings, check catalog.
AB Severe theophylline intoxication is a medical emergency
that can lead to cardiac arrhythmias, convulsions and cardiovascular collapse
not infrequently leading to permanent morbidity or mortality. We describe a
30-yr-old patient with a peak serum theophylline level of 87
mg/l treated with haemoperfusion using a coated charcoal-filled column. A
review of the literature concerning theophylline toxicity,
supportive care, outcome and the possible indications for the use of
extracorporeal haemoperfusion is given. A summary of possible conservative
measures is given. It is concluded that haemoperfusion is the extracorporeal
treatment of choice and should be considered in case of
theophylline serum levels above 80 mg/l even without signs
of major toxicity. For certain patients with conditions increasing the risks
of prolonged or severe toxicity even lower serum
theophylline levels may warrant the use of haemoperfusion.
[References: 74]

<8>
AN 91238002
AU Anonymous.
TI Theophylline. [Review] [202 refs]
SO IARC Monographs on the Evaluation of Carcinogenic Risks to Humans.
51:391-419, 1991.
LM Dana Biomedical Library (Dana).

<9>
AN 91184627
AU Poe RH. Utell MJ.
IN Pulmonary Unit, Highland Hospital, Rochester, NY.
TI Theophylline in asthma and COPD: changing perspectives and
controversies. [Review] [46 refs]
SO Geriatrics. 46(4):55-6, 61-5, 1991 Apr.
LM Pre-1993 Dana; 1993-dateMFHSL;for Web access-check catalog
AB Theophylline's role in the treatment of airway obstruction
has been challenged, yet it remains a useful agent in the management of
obstructive lung disease. It has a narrow therapeutic range and frequent side
effects. Drug interactions are common, and variations in
theophylline clearance among patients arise from individual
differences in its absorption, metabolism, and elimination. Acute
bronchospasm is best treated with inhaled sympathomimetic agents, but the
nonbronchodilator effects of theophylline offer therapeutic
benefits for the patient with non-reversible disease. When properly monitored
by serum level determinations, theophylline may be used as
an adjunct to aerosol therapy and corticosteroids in asthma. However, the
patient with COPD may benefit the most from an empiric trial of the drug,
using lower doses than were commonly employed in the past. [References: 46]