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Since absorption of nebulized and subcutaneous terbutaline may be delayed or decreased during episodes of severe asthma, a preliminary trial of intravenous terbutaline was instituted in five adult patients with status asthmaticus. The terbutaline was administered as a bolus followed by a continuous infusion of 0.1-0.4 micrograms/kg/min. Although three patients may have received some improvement, the impact of intravenous terbutaline could not be distinguished from other concomitant therapy. All patients experienced tolerable adverse reactions. Further research to evaluate higher doses administered early in the hospital course and to determine receptor sensitivity needs to be conducted.

Beta-adrenergics are used frequently in the management of asthma. Tremor has been found to be a limiting side effect with the oral or the inhaled forms. We describe one child who developed gross tremors necessitating an extensive neurologic evaluation to eliminate any other cause. With the results of a normal work-up and the reappearance of tremor when challenged again, the diagnosis of increased sensitivity to the tremorogenic effect of beta-adrenergics was made.

Approximately 15 to 20 minutes are usually required to administer adrenergic agents by nebulization in the treatment of asthma. But young children often do not tolerate these prolonged treatment periods. A "5-breath" method was found to provide comparable improvements in pulmonary function and result in minimal and comparable side effects, but required only one minute to administer. The "5-breath" method may, therefore, be the method of choice in the young or otherwise uncooperative patients.

We presented a patient with status asthmaticus treated with a combination of theophylline and prednisone who developed a perforated gastric ulcer. The relative etiologic significance of the stress of status asthmaticus, administration of theophylline, or corticosteroids is open to question. The literature, except for anecdotal reports, does not support a significant increase of ulcers in asthmatic patients on either theophylline or steroids. A study following large patient groups on theophylline and a combination of theophylline and steroids might clarify the risk of ulcer formation in patients being treated with these medications for asthma.

Five different doses of enprofylline, a 3-propylxanthine, were compared with a standard dose of theophylline in 135 episodes of acute asthma in a double-blind study. The drugs were administered intravenously during ten minutes. Enprofylline induced dose-related bronchodilation and the 2.5 mg/kg dose produced significantly better effects than theophylline.

Twenty-three patients with acute severe asthma were treated in a randomized double-blind way by either intravenous terbutaline two times at an hour interval 6 micrograms/kg or inhaled terbutaline two times 0.1 mg/kg. Peak expiratory flow rate in percent of expected value rose from 89 L/min to 128 L/min (P less than .01) in the intravenous group and from 97 L/min to 122 L/min (P less than .02) in the inhalation group; this was comparable for both groups. PaO2 initially was 7.55 kPa in the intravenous group and rose by 1.4 after 60 minutes (P less than .02) and by 1.33 after 120 minutes (P less than .01). The mean PaO2 did not change in the inhalation group. The pulse rate and blood pressure did not vary significantly in either of the two groups. We conclude that both the intravenous and inhalational administration of terbutaline are effective in acute severe asthma, but that the intravenous route is possibly better for increasing PaO2.

This is a summary of five pediatric cases of unresponsive status asthmaticus treated with frequent subcutaneous injections of terbutaline. The lack of adverse cardiovascular complications make this an alternative to other procedures that have greater risk.