IV Theophylline Still Works in Severe Status Asthmaticus

Abstract

Critical Care| August 01 2001 IV Theophylline Still Works in Severe Status Asthmaticus AAP Grand Rounds (2001) 6 (2): 13–14. https://doi.org/10.1542/gr.6-2-13 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation IV Theophylline Still Works in Severe Status Asthmaticus. AAP Grand Rounds August 2001; 6 (2): 13–14. https://doi.org/10.1542/gr.6-2-13 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: status asthmaticus, theophylline Source: Ream RS, Loftis LL, Albers GM, et al. Efficacy of IV theophylline in children with severe status asthmaticus. Chest. 2001;119:1480–1488. Forty-seven children (median age, 8.3 years; range, 13 months to 17 years) were enrolled in a randomized controlled study at Cardinal Glennon Pediatric Research Institute, Saint Louis University, to examine the role of theophylline in severe asthma. All children were treated with methylprednisolone, continuous nebulized albuterol and intermittent nebulized ipratropium bromide. Intravenous terbutaline sulfate was added to the “standard care” regimen when the patients had increased levels of respiratory distress or a rising PaCO2. Children were randomized to receive additional theophylline or “standard” care alone. Target theophylline levels were 12–17 mcg/ml. The Wood Downes1 Clinical Asthma Score was used to assess asthma severity and was assigned by a physician blinded to the treatment assignment. Twenty-three children received theophylline and 24 received “standard” therapy without theophylline. The treatment and control groups had similar ages, Clinical Asthma Scores, blood gases values, baseline use of anti-inflammatory therapy and intensity of acute asthma care in the emergency department. Three children in each group received mechanical ventilation that was initiated prior to institution of theophylline. Among children who did not require mechanical ventilation, those treated with theophylline had more rapid improvement in Clinical Asthma Scores compared to the control group. The average time to a clinical asthma score of < 3 was 19 hours for the theophylline group compared to 31 hours in the control group (P<.05). However, the average length of stay in the ICU did not differ between treatment groups for children who did not receive mechanical ventilation. Among children who received mechanical ventilation, both the time to a Clinical Asthma Score < 3 (66 hours vs 191 hours) and the time to discharge criteria from the ICU (3.9 days vs 8.8 days) were significantly shorter for the children treated with theophylline. The average doses of continuous nebulized albuterol and intravenous terbutaline did not differ between the treatment groups. Children who received theophylline experienced significantly more vomiting. The authors suggest that combined therapy that includes theophylline for children with severe asthma exacerbations may reduce the incidence of respiratory failure and decrease hospital length of stay. In the recent past, theophylline was a mainstay of acute, severe asthma therapy. For acute bronchodilation, it has largely been replaced by aggressive administration of ß-agonists that have a much broader therapeutic index. Theophylline continues to be recommended as chronic therapy for children with persistent wheezing despite use of inhaled steroids and ß-agonists and for children with nocturnal wheezing.2 Toxicity is common and includes nausea, headache, insomnia, seizure, encephalopathy, electrolyte abnormalities and cardiac arrhythmias. Simultaneous administration of other drugs such as cimetidine and erythromycin interfere with drug clearance and may lead to toxic levels. This study is the second report demonstrating a benefit when theophylline was added to “standard” therapy (systemic corticosteroids, inhaled and intravenous ß-agonists and inhaled anticholinergics) for severe asthma exacerbations. The first... You do not currently have access to this content.