[Treatment of status asthmaticus. Prospective evaluation of a protocol combining aminophylline and terbutaline (44...

The treatment of status asthmaticus remains poorly defined. Even the definition of the condition is controversial. We have therefore attempted to define a therapeutic protocol consisting of a combination of terbutaline, aminophylline and hydrocortisone administered parenterally. We have conducted a prospective evaluation of the effectiveness and tolerance of this protocol. 44 consecutive patients with status asthmaticus (defined as an abnormally severe episode of asthma with early or marked alveolar hypoventilation: PaCO2 greater than or equal to 5.20 kPa) were entered into the study over a period of 56 months. The effectiveness of this combination is reflected by the rapid improvement in the clinical and blood gas parameters, the relatively rare use of mechanical ventilation (of brief duration) and the low mortality. The tolerance proved to be excellent, as the terbutaline only had to be stopped in 1 case (permanently) and the aminophylline in one other case (temporarily). These initial results encourage us to a more aggressive approach in the early treatment of status asthmaticus with particular attention to the associated metabolic acidosis.