• Derek S Wheeler, Brian R Jacobs, Charlotte A Kenreigh, Judy A Bean, Tamara K Hutson, and Richard J Brilli.
• Department of Pediatrics, University of Cincinnati College of Medicine, Division of Critical Care Medicine, OH 45229, USA. derek.wheeler@cchmc.org
• Pediatr Crit Care Me. 2005 Mar 1;6(2):142-7.

ObjectiveTo 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.DesignRandomized, prospective, controlled, double-blind trial.SettingPediatric intensive care unit of a tertiary-care children's medical center.PatientsForty critically ill children between the ages of 3 and 15 yrs with impending respiratory failure secondary to status asthmaticus.InterventionsAll 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 ResultsDifferences 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).ConclusionsTheophylline, 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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