Theophylline versus terbutaline in treating critically ill children with status asthmaticus: A prospective, randomized, controlled trial

Derek S. Wheeler*, Brian R. Jacobs, Charlotte A. Kenreigh, Judy A. Bean, Tamara K. Hutson, Richard J. Brilli

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Scopus citations

Abstract

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 vs. $3,908 vs. $4,045, 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.

Original languageEnglish (US)
Pages (from-to)142-147
Number of pages6
JournalPediatric Critical Care Medicine
Volume6
Issue number2
DOIs
StatePublished - Mar 1 2005
Externally publishedYes

Keywords

  • β-adrenergic
  • β-agonist
  • Asthma
  • Child
  • Critical care
  • Intravenous bronchodilator
  • Theophylline

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

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