Cardiac toxicity of intravenous terbutaline for the treatment of severe asthma in children: a prospective assessment.
OBJECTIVE
To examine the cardiac toxicity as measured by elevations in serum cardiac troponin T (cTnT) and to compare creatine kinase (CK) and creatine kinase MB (CK-MB) and findings on electrocardiography (ECG) as markers of cardiac toxicity with cTnT during the infusion of intravenous terbutaline for the treatment of severe asthma in children.


METHODS
Prospective cohort study of patients receiving intravenous terbutaline for severe asthma.


RESULTS
Only 3 (10%) of the 29 patients had elevations in cTnT. Each underwent mechanical ventilation for >72 hours, which was the earliest point at which cTnT elevations were identified. Eighteen (62%) patients had an elevation in CK, and 3 had an elevation in CK-MB fraction without an elevated cTnT. Twenty (69%) patients had ECG findings consistent with ischemia, and 19 of these patients had the ischemic findings on their preterbutaline ECG. Elevations in CK and CK-MB and ischemic changes on ECG did not correlate with elevations in cTnT. Both mechanical ventilation (P =.02) and prolonged administration (>72 hours) of intravenous terbutaline (P =. 02) were significantly associated with elevations in cTnT.


CONCLUSIONS
We found no clinically significant cardiac toxicity from the use of intravenous terbutaline for severe asthma as measured by serum cTnT elevations.
Chiang
V W
VW
Division of Emergency Medicine and the Departments of Anesthesia and Laboratory Medicine, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Burns
J P
JP
Rifai
N
N
Lipshultz
S E
SE
Adams
M J
MJ
Weiner
D L
DL
D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000097:blood / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003401:Creatine / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006321:Heart / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D007527:Isoenzymes; D008297:Male; D011446:Prospective Studies; D013726:Terbutaline / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D014336:Troponin / Q000097:blood
D000318:Adrenergic beta-Agonists; D007527:Isoenzymes; D014336:Troponin; D003402:Creatine Kinase; D003401:Creatine; D013726:Terbutaline