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Theophylline versus terbutaline in treating critically ill children with status asthmaticus: a prospective,
Derek S Wheeler1, Brian R Jacobs, Charlotte A Kenreigh
1Department of Pediatrics, University of Cincinnati College of Medicine, Division of Critical Care Medicine, OH 45229, USA. derek.wheeler@cchmc.org
Insights
Theophylline is as effective as terbutaline for treating critically ill children with status asthmaticus and is more cost-effective. Early consideration of theophylline is recommended for managing severe asthma in pediatric patients.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Respiratory Medicine
Background:
- Status asthmaticus in critically ill children requires effective treatment strategies.
- Current management often includes continuous nebulized albuterol and intravenous corticosteroids.
- The role of additional bronchodilators like theophylline and terbutaline needs further clarification.
Purpose of the Study:
- To compare the efficacy and cost-effectiveness of theophylline, terbutaline, or a combination of both.
- To evaluate these treatments in critically ill children with status asthmaticus already receiving standard care.
- To determine the optimal therapeutic approach for severe pediatric asthma exacerbations.
Main Methods:
- A randomized, prospective, controlled, double-blind trial was conducted.
- Forty critically ill children (3-15 years) with impending respiratory failure due to status asthmaticus were enrolled.
- Patients received continuous nebulized albuterol and intravenous corticosteroids, with three groups receiving either theophylline, terbutaline, or both.
Main Results:
- No significant differences in clinical asthma scores, pediatric intensive care unit length of stay, or adverse events were observed between the groups, except for increased nausea with combination therapy.
- Theophylline monotherapy was significantly more cost-effective than terbutaline alone or combination therapy.
- Theophylline blood levels were monitored and found to be significantly lower in the theophylline monotherapy group.
Conclusions:
- Theophylline is as effective as terbutaline when added to standard therapy for critically ill children with status asthmaticus.
- Adding theophylline to baseline treatment offers a more cost-effective option compared to terbutaline.
- Theophylline should be considered early in the management of severe pediatric asthma exacerbations.
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.
Design:
Randomized, prospective, controlled, double-blind trial.
Setting:
Pediatric intensive care unit of a tertiary-care children's medical center.
Patients:
Forty critically ill children between the ages of 3 and 15 yrs with impending respiratory failure secondary to status asthmaticus.
Interventions:
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).
Measurements And Main 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.
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