Theophylline versus terbutaline in treating critically ill children with status asthmaticus: a prospective, randomized, controlled trial.
OBJECTIVE
To compare the efficacy of theophylline, terbutaline, or theophylline combined with terbutaline treatment in critically ill children with status asthmaticus who are already receiving continuous nebulized albuterol and intravenous corticosteroids.


METHODS
Randomized, prospective, controlled, double-blind trial.


METHODS
Pediatric intensive care unit of a tertiary-care children's medical center.


METHODS
Forty critically ill children between the ages of 3 and 15 yrs with impending respiratory failure secondary to status asthmaticus.


METHODS
All patients received intravenous methylprednisolone and continuous nebulized albuterol. The three study groups received theophylline plus placebo (group 1), terbutaline plus placebo (group 2), or theophylline and terbutaline together (group 3).


RESULTS
Differences in baseline characteristics, change in clinical asthma score over time, length of pediatric intensive care unit stay, and incidence of adverse events were determined. The three study groups were similar in age, gender, race, asthma severity, and treatment. There were no differences in clinical asthma score over time, length of pediatric intensive care unit stay, or incidence of adverse events between the three groups, with the exception of a higher incidence of nausea in children in group 3. The median hospital cost of medication and theophylline blood levels was significantly lower in group 1 compared with groups 2 and 3 (280 US dollars vs. 3,908 US dollars vs. 4,045 US dollars, respectively, p < .0001).


CONCLUSIONS
Theophylline, when added to continuous nebulized albuterol therapy and intravenous corticosteroids, is as effective as terbutaline in treating critically ill children with status asthmaticus. The addition of theophylline to baseline therapy is more cost-effective when compared with terbutaline alone or terbutaline and theophylline together. Theophylline should be considered for use early in the management of critically ill asthmatic children.
Wheeler
Derek S
DS
Department of Pediatrics, University of Cincinnati College of Medicine, Division of Critical Care Medicine, OH 45229, USA. derek.wheeler@cchmc.org
Jacobs
Brian R
BR
Kenreigh
Charlotte A
CA
Bean
Judy A
JA
Hutson
Tamara K
TK
Brilli
Richard J
RJ
D000293:Adolescent; D000420:Albuterol / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D011446:Prospective Studies; D013224:Status Asthmaticus / Q000188:drug therapy*; D013726:Terbutaline / Q000008:administration & dosage*; D013806:Theophylline / Q000008:administration & dosage*; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D005938:Glucocorticoids; D013806:Theophylline; D013726:Terbutaline; D000420:Albuterol; D008775:Methylprednisolone