Efficacy of IV theophylline in children with severe status asthmaticus

Study objective: To determine whether adding IV theophylline to an aggressive regimen of inhaled and IV beta -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 assignment. 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 less than or equal to 2 h and who were in severe distress, as indicated by a modified Wood-Downes clinical asthma score (CAS) of greater than or equal to 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 mug/mL. A CAS was tabulated twice daily. 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 less than or equal to 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.