Aims To answer the question, in children with acute severe asthma, what is the best second line treatment; intravenous beta2 agonist, Aminophylline or Magnesium Sulphate, (MgSo4).
Methods We searched the literature using the words: Aminophylline/Salbutamol, Magnesium Sulphate/Asthma and child in June 2011).
Results Out of the fourteen articles which were found, only 4 were relevant. The first; an RCT compared IV MgSo4, Terbutaline and Aminophylline in acute severe asthma. Improvement in clinical Asthma severity score (CASS) was used as an outcome measure. They found that MgSo4 is superior with best response and least side effects.
The second study, an RCT, compared a single bolus of Salbutamol to a continuous Aminophylline infusion. No significant difference between the two groups was found over the first two hours; however the Aminophylline group had a shorter hospital stay.
A third paper studied if the addition of intravenous terbutaline provides any clinical benefit as a second treatment in acute severe asthma. Again CASS was used as outcome measure. No statistical significance between the two groups was found although outcome measures revealed a trend toward improvement in the terbutaline group.
Conclusion There is evidence of the effectiveness of the different second line treatments but limited evidence that one is superior to other. A single study suggests MgSo4 as the most effective. Large well designed trials are needed to accurately answer this question. Till then any of the three treatments can be used depending on individual unit experience and preference.
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