Editor,—Although the in-hospital mortality from refractory status asthmaticus is low, the treatment strategies used in the management of these patients may cause significant morbidity.1-3 Those children who require ventilation either for resuscitation or impending respiratory collapse often require the addition of “unconventional” adjuvant bronchodilator treatments, such as intravenous β₂agonists,4 ketamine,5 or magnesium,6 aimed at reduction of ventilator induced volutrauma.

Inhaled anaesthetic gases are known to produce sustained bronchodilatation in refractory status asthmaticus, possibly mediated by airway reflex blockade and a direct effect on smooth muscle.7-9 We wish to highlight the use of inhaled isoflurane in two children with severe life threatening asthma, and in particular, the importance of guiding treatment by continuous intra-arterial blood gas analysis (Paratrend 7, Biomedical Sensors, High Wycombe).10

Patient A …