WIP 34 - Exploring the Combined Use of Terbutaline/Aminophylline for Management of Pediatric Status Asthmaticus: A Single Center Retrospective Chart Review

Publication Number: WIP 34.7702

Kelly N. McIntyre, University of Louisville, Louisville, KY, United States; Kelly A. Lyons, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, KY, United States; Katherine Potter, University of Louisville, Louisville, KY, United States; John W. Berkenbosch, UNIVERSITY OF LOUISVILLE, LOUISVILLE, KY, United States

Background: Asthma is one of the most common respiratory illnesses leading to hospitalization within the pediatric population. During severe asthma exacerbations, otherwise known as “status asthmaticus”, children often require both admission to the pediatric intensive care unit (PICU) and escalation beyond first line bronchodilator therapy (i.e. albuterol). In these cases, medications considered second and third line agents such as additional beta two agonists (i.e. terbutaline) and methylxanthines (i.e. aminophylline) have been utilized. Guidelines on how to escalate therapies for status asthmaticus, including which second and third line medications to utilize, has been limited within the PICU setting and led to variations in practice. Further, there is limited data describing the safety and efficacy of these third line agents when used in combination versus separately for status asthmaticus.

Objective: Describe the outcomes of combined intravenous terbutaline/aminophylline (TB/AM) for third line management of pediatric status asthmaticus as compared to conventional non-combination therapy including impact on length of stay and maximal respiratory support. We secondarily aim to investigate adverse patient events related to the combined medications.

Design/Methods: We conducted a retrospective chart review of pediatric patients with a history of asthma admitted to the PICU at our tertiary children’s hospital for status asthmaticus. All study participants met the following inclusion criteria: age 2- 18 years and had to receive TB/AM third line therapy. Patients were excluded if they had a tracheostomy, were on home respiratory support, or did not have prior diagnosis of asthma. Our study was approved by the Institutional Review Board at our tertiary children’s hospital. Demographic and clinical data were collected including length of stay, duration of medication, adverse events, and maximal needed respiratory support. Those included were compared to a matched control group. Ongoing quantitative data analysis including logistic regression is occurring.