P0520 - The impact of terbutaline as adjuvant therapy in the treatment of severe acute asthma exacerbation in the pediatric emergency department

INTRODUCTION
Recent pharmaceutical shortages in continuous inhaled β-agonist medications forced us to look at alternative uses of currently available medications for the treatment of acute asthma exacerbations. We elected to recommend a single dose of subcutaneous terbutaline as adjuvant therapy to our current treatment algorithm for severe acute asthma exacerbation at our hospital.

PATIENTS AND METHODS
Patients were identified using a retrospective cohort analysis from a single quaternary urban children’s hospital. Patients age 2 to 18 years old were included if they had a diagnosis of acute asthma exacerbation, an initial Respiratory Clinical Score (RCS) of ≥ 9, and presented directly to our emergency department. Patients who initiated treatment at an outside facility were excluded.

A total of 787 patients were identified during the study timeframe (12/16/17 – 12/31/18), and of those, 651 patients met study criteria and were included in the analysis. Chi-square test was used to establish p-values for categorical variables. For normally distributed variables, a t test was utilized. For non-normally distributed variables, a Kruskal-Wallis test was utilized. A p-value of ≤0.05 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 ED also had a higher risk of admission to the hospital (OR 1.55; CI 1.08-2.22, p=0.020) as compared to their non-terbutaline 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 (Table 3). There was no statistically significant difference in length of stay (p =0.298), BiPAP/CPAP use (p= 0.107). The patients on terbutaline were relatively more likely to require oxygen (p=0.003) and IM epinephrine (p= 0.010) than the patients not on terbutaline.

CONCLUSIONS
Terbutaline administration given to pediatric patients experiencing severe asthma exacerbations was not associated with decreased hospital floor or intensive care unit admissions. The study is limited given that it was a retrospective analysis, and the administration of terbutaline was at the clinical discretion of the treating physician. Further randomized controlled trials are needed to assess the role of terbutaline in severe acute asthma exacerbation in pediatric patients.