To determine the effects of intravenous terbutaline in the treatment of status asthmaticus.
Eighteen children (2 to 17 years) with status asthmaticus failing therapy with inhaled β-agonist, intravenous corticosteroid, and ipratropium bromide.
Patients were treated with aerosolized ipratropium bromide and intravenous corticosteroid concurrently with intravenous terbutaline infusion. The dose of terbutaline ranged from 0.05 to 10.0 μg/kg/minute. Patients receiving doses of 0.4 to 2.0 μg/kg/minute required intravenous epinephrine to counteract a drop in diastolic blood pressure (mean, 27 mm Hg; range 10–50). When the terbutaline dose was >2 μg/kg/min, there was no longer need for epinephrine. There were no significant arrhythmias noted but 3 patients who were also receiving epinephrine had transient ST segment depression. The creatinine phosphokinase-myocardial band (CPK-MB) levels elevated but not in relation to the terbutaline dose. Ten of the 18 patients required mechanical ventilation. There were no deaths in the group.
This study was conducted without a loading dose of terbutaline as reported in other papers. The patients demonstrated safety at these dosing ranges but >50% of the patients required mechanical ventilation.