Study objective: To determine whether adding IV
theophylline to an aggressive regimen of inhaled and IV β-agonists,
inhaled ipratropium, and IV methylprednisolone would enhance the
recovery of children with severe status asthmaticus admitted to the
pediatric ICU (PICU).
Design: A prospective,
randomized, controlled trial. Asthma scoring was performed by
investigators not involved in treatment decisions and blinded to group
Setting: The PICU of an urban,
university-affiliated, tertiary-care children’s hospital.
Patients: Children with a diagnosis of status asthmaticus
who were admitted to the PICU for ≤ 2 h and who were in severe
distress, as indicated by a modified Wood-Downes clinical asthma score
(CAS) of ≥ 5.
Interventions: All subjects initially
received continuous albuterol nebulizations; intermittent, inhaled
ipratropium; and IV methylprednisolone. The theophylline group was also
administered infusions of IV theophylline to achieve serum
concentrations of 12 to 17 μg/mL. A CAS was tabulated twice
Measurements and results: Forty-seven children
(median age, 8.3 years; range, 13 months to 17 years) completed the
study. Twenty-three children received theophylline. The baseline CASs
of both groups were similar and included three subjects receiving
mechanical ventilation in each group. All subjects receiving mechanical
ventilation and theophylline were intubated before drug infusion. Among
the 41 subjects who were not receiving mechanical ventilation, those
receiving theophylline achieved a CAS of ≤ 3 sooner than control
subjects (18.6 ± 2.7 h vs 31.1 ± 4.5 h; p < 0.05).
Theophylline had no effect on the length of PICU stay or the total
incidence of side effects. Subjects receiving theophylline had more
emesis (p < 0.05), and control patients had more tremor
(p < 0.05).
Conclusions: Theophylline safely
hastened the recovery of children in severe status asthmaticus who were
also receiving albuterol, ipratropium, and methylprednisolone. The role
of theophylline in the management of asthmatic children in impending
respiratory failure should be reexamined.