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Adair E, Dibaba D, Fowke JH, et al. The Impact of Terbutaline as Adjuvant Therapy in the Treatment of Severe Asthma in the Pediatric Emergency Department. Pediatr Emerg Care. 2022;38(1):e292-e294doi: 10.1097/PEC.0000000000002269.
Adair, E., Dibaba, D., Fowke, J. H., & Snider, M. (2022). The Impact of Terbutaline as Adjuvant Therapy in the Treatment of Severe Asthma in the Pediatric Emergency Department. Pediatric emergency care, 38(1), e292-e294. https://doi.org/10.1097/PEC.0000000000002269
Adair, Erik, et al. "The Impact of Terbutaline as Adjuvant Therapy in the Treatment of Severe Asthma in the Pediatric Emergency Department." Pediatric emergency care vol. 38,1 (2022): e292-e294. doi: https://doi.org/10.1097/PEC.0000000000002269
Adair E, Dibaba D, Fowke JH, Snider M. The Impact of Terbutaline as Adjuvant Therapy in the Treatment of Severe Asthma in the Pediatric Emergency Department. Pediatr Emerg Care. 2022 Jan 01;38(1):e292-e294. doi: 10.1097/PEC.0000000000002269. PMID: 33136831.
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Pediatr Emerg Care. 2022 Jan 01;38(1):e292-e294. doi: 10.1097/PEC.0000000000002269.

The Impact of Terbutaline as Adjuvant Therapy in the Treatment of Severe Asthma in the Pediatric Emergency Department.

Pediatric emergency care

Erik Adair, Daniel Dibaba, Jay H Fowke, Mark Snider

Affiliations

  1. Tennessee Clinical and Translational Science Institute.
  2. Division of Epidemiology, Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN.

PMID: 33136831 DOI: 10.1097/PEC.0000000000002269

Abstract

METHODS: Patients were identified using a retrospective cohort analysis from a single, tertiary care, urban children's hospital. Patients presenting directly to our emergency department aged 2 to 18 years were included if they had a diagnosis of severe asthma exacerbation, defined by an initial Respiratory Clinical Score (RCS) of 9 or higher. A total of 787 patients were identified during the study timeframe (December 16, 2017, to December 31, 2018), and of those, 651 patients met study criteria and were included in the analysis. The χ2 test was used to establish P values for categorical variables. For normally distributed variables, a t test was used. For nonnormally distributed variables, the Kruskal-Wallis test was used. A P value of 0.05 or less was interpreted as statistically significant.

RESULTS: Patients who received terbutaline had an increased risk of admission to the PICU (P < 0.001). This association was lost after controlling for age, sex, continuous albuterol use, and intramuscular epinephrine use (P = 0.362). Patients receiving terbutaline in the emergency department also had a higher risk of admission to the hospital (odds ratio, 1.55; confidence interval, 1.08-2.22; P = 0.020) as compared with their nonterbutaline counterparts. Overall, patients in the terbutaline group had a higher initial RCS at presentation. Upon further analysis, patients with the same RCS at presentation were more likely to be admitted if they received terbutaline than those who did not. There was no statistically significant difference in length of stay (P = 0.298) and BiPAP/CPAP use (P = 0.107). The patients on terbutaline were relatively more likely to require oxygen (P = 0.003) and intramuscular epinephrine (P = 0.010) than the patients not on terbutaline.

CONCLUSIONS: Terbutaline administration given to pediatric patients experiencing a severe asthma exacerbation was not associated with decreased PICU or general hospital floor admission. The study is limited given that it was a retrospective analysis. Further randomized controlled trials are needed to assess the role of terbutaline in severe acute asthma exacerbations in pediatric patients.

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Conflict of interest statement

Disclosure: The authors declare no conflict of interest.

References

  1. CDC, C.f.D.C.a.P., National Center for Health Statistics. 2016 National Health Interview Survey (NHIS) Raw Data. 2016. Available at: https://www.cdc.gov/asthma/nhis/2016/data.htm. Accessed December 21, 2018. - PubMed
  2. CDC, C.f.D.C.a.P., National Center for Health Statistics. 2010 National Hospital Discharge Survey (NHDS) Data. 2010. Available at: https://www.cdc.gov/nchs/nhds/index.htm. Accessed December 21, 2018. - PubMed
  3. CDC, C.f.D.C.a.P., National Center for Health Statistics. Underlying Cause of Death 1999–2017 on CDC WONDER Online Database, Released December, 2018. Data Are From the Multiple Cause of Death Files, 1999–2017, as Compiled From Data Provided by the 57 Vital Statistics Jurisdictions Through the Vital Statistics Cooperative Program. 2015–2017. Available at: http://wonder.cdc.gov/ucd-icd10.html. Accessed December 21, 2018. - PubMed
  4. Rehder KJ. Adjunct therapies for refractory status asthmaticus in children. Respir Care. 2017;62:849–865. - PubMed
  5. Papiris SA, Manali ED, Kolilekas L, et al. Acute severe asthma: new approaches to assessment and treatment. Drugs. 2009;69:2363–2391. - PubMed
  6. Nievas IF, Anand KJ. Severe acute asthma exacerbation in children: a stepwise approach for escalating therapy in a pediatric intensive care unit. J Pediatr Pharmacol Ther. 2013;18:88–104. - PubMed
  7. Liu LL, Gallaher MM, Davis RL, et al. Use of a respiratory clinical score among different providers. Pediatr Pulmonol. 2004;37:243–248. - PubMed
  8. Doymaz S, Schneider J. Safety of terbutaline for treatment of acute severe pediatric asthma. Pediatr Emerg Care. 2018;34:299–302. - PubMed
  9. Doymaz S, Schneider J, Sagy M. Early administration of terbutaline in severe pediatric asthma may reduce incidence of acute respiratory failure. Ann Allergy Asthma Immunol. 2014;112:207–210. - PubMed
  10. Travers AH, Milan SJ, Jones AP, et al. Addition of intravenous beta(2)-agonists to inhaled beta(2)-agonists for acute asthma. Cochrane Database Syst Rev. 2012;12:CD010179. - PubMed
  11. Bratton SL, Newth CJL, Zuppa AF, et al. Critical care for pediatric asthma: wide care variability and challenges for study. Pediatr Crit Care Med. 2012;13:407–414. - PubMed
  12. Lebovitz DJ, Smith PG, O'Riordan MA, et al. Pharmacokinetic properties and tolerability of single-dose terbutaline in patients with severe asthma treated in the pediatric intensive care unit. Curr Ther Res Clin Exp. 2004;65:98–109. - PubMed

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