Of the 48 patients, 24 received terbutaline, and 24 received epinephrine. The average age of the group receiving terbutaline was nine years (range, 4 to 16 years) and of those receiving epinephrine was seven years (range, 2 to 13 years). Appreciable clinical improvement was noted in 19 of 24 patients in both groups and was of comparable magnitude. All of the patients were grouped into four subgroups, those receiving one injection of terbutaline or of epinephrine and those receiving two injections of terbutaline or of epinephrine. Although more patients required two injections of terbutaline (11/24) than of epinephrine (5/24), the difference was not significant (P > 0.05 by x2 analysis).
Side effects were noted in four patients receiving terbutaline and five patients receiving epinephrine and consisted of mild degrees of vomiting, tremors, or chills. The findings from the blood cell counts, urinalysis, and automated analysis of multiple blood chemical constituents showed no evidence of toxicity.
Thirteen patients were able to perform a forced expiratory maneuver well enough to allow calculation of the FEVi. The seven patients receiving terbutaline showed an average improvement of 40 percent, which was significant (P < 0.05), while the six receiving epinephrine improved 23 percent, which was not significant (P > 0.05). We hesitate to put undue emphasis on these results because of the small numbers of patients and because the severity of the acute asthma may have precluded reliable performance of the texts.
The clinical index of obstruction of the airway of patients before and after therapy (Fig 1) shows that all four groups of patients had significant improvement at 30 and 60 minutes (P < 0.01 for both the paired f-test and the nonparametric Mann-Whitney U test). The difference between the scores at 30 and 60 minutes was not significant in any of the groups (P>0.05). The patients in the groups receiving two injections of terbutaline or epinephrine were more severely ill, as indicated by significantly higher clinical indices initially and at 30 and 60 minutes (P<0.01), as compared to those in the groups receiving only one injection. There was no significant difference when the clinical scores of those receiving one injection of terbutaline were compared with those receiving one injection of epinephrine or when the clinical scores of those receiving two injections of terbutaline were compared with those receiving two injections of epinephrine (P > 0.05).
A summary of all physiologic measurements is presented in Table 1. The only significant change in heart rate occurred at 15 and 30 minutes in the group receiving one injection of terbutaline, when the heart rate increased (P < 0.01). Although the mean heart rate before treatment was lowest in this group, the value was not significantly different from the value before treatment of the other patients (P > 0.05). We were unable to detect a significant correlation between the initial heart rate and the increase in heart rate at 15 minutes in this group.
An analysis of variance showed a significant decrease in the respiratory rate at 15, 30, and 60 minutes, as compared to values before treatment in those patients receiving only one injection of either drug (P < 0.01) (Table 1). At any point in time, the two groups were not significantly different from each other (P > 0.05).The effect of terbutaline and epinephrine on systemic arterial pressure is shown in Table 1. Analysis of variance showed no significant change in systolic blood pressure (P>0.05); however, there was a significant fall in diastolic blood pressure at 15 minutes (P < 0.05) with both drugs. No significant relationship was found in any of the groups of patients between the change in heart rate and the change in diastolic blood pressure (P > 0.05).
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Figure 1. Clinical indices of obstruction of airway in all four groups before and 30 and 60 minutes following initial therapy. Tj and T2 refer to groups receiving one and two injections of terbutaline, respectively. E1 and E2 refer to groups receiving one and two injections of epinephrine respectively. Second injections were given at 30 minutes (see text for scoring system).
Table 1—Effect of Terbutaline and Epinephrine on Heart Rate, Respiratory Rate, and Blood Pressure in Acute Asthma
|Data and Group 0 min 15 minHeart rate, beats per minute One injection of terbutaline 115.8 ±6.2 126.2 ±7.3** One injection of epinephrine 123.2 ± 5.6 120.4 ± 6.5 Two injections of terbutaline 128.2 ±4.8 131.3 ±4.6 Two injections of epinephrine 138.0 ± 7.6 135.6 ± 6.5||30 min129.5 ±8.5** 122.4 ±6.1 129.9 ±5.3 136.0 ±8.0||60 min121.6±8.1123.0 ±6.5 132.8 ±3.4138.0 ±6.6|
|Respiratory rate, breaths per minute One injection of terbutaline 32.1 ± 2.6 27.8 ± 2.6 * * One injection of epinephrine 35.4 ±3.4 28.4 ±2.4** Two injections of terbutaline 30.7 ± 3.3 30.7 ± 3.9 Two injections of epinephrine 42.0 ± 4.2 40.0 ±5.4||29.9 ±2.4**27.9 ±3.2** 30.5 ±4.1 37.2 ±4.0||27.4 ±1.8** 28.2 ±3.1** 29.6 ±3.836.4 ±5.2|
|Systolic blood pressure, mm Hg One injection of terbutaline 97.8 ± 3.0 99.3 ± 3.6 One injection of epinephrine 101.1 ± 2.9 103.7 ± 3.4 Two injections of terbutaline 101.5 ±3.3 99.1 ± 3.3 Two injections of epinephrine 106.0 ±4.8 105.0 ±4.2||99.8 ±4.0 104.2 ±3.496.8 ±4.5 103.0 ±3.7||103.8 ±4.0 101.4 ±3.0 96.3 ±4.1 107.0 ±3.0|
|Diastolic blood pressure, mm Hg One injection of terbutaline 68.1 ±3.5 64.5 ± 2.01 One injection of epinephrine 70.8 ± 3.2 67.1 ± 2.21 Two injections of terbutaline 67.7 ±3.5 65.0 ± 3.4f Two injections of epinephrine 76.0 ±2.9 72.4 ± 3.81||65.8 ±2.168.8 ±2.5 65.7 ±3.1 72.2 ±5.3||72.5 ±3.770.6 ±2.6 64.0 ±2.8 70.2 ±4.0|