Cardiac Troponin I Levels in Children with Acute Severe Asthma Treated with IV Salbutamol

Acute severe asthma attacks in children are life-threatening emergencies. With appropriate and prompt treatment most children recover uneventfully. When complications occur, they are usually a consequence of disease progression and/or its treatment. Established cardiac complications associated with acute asthma treatment in children include supraventricular tachycardia (SVT) and acute coronary ischaemia. 

More recently, two groups have reported elevated cardiac troponin I (CTnI) levels in children treated foracute asthma. In this case series, the raised levels of CTnI were not generally accompanied by overt symptoms or signs of coronary ischaemia. Following an index case of a child with acute severe asthma who developed acute coronary ischaemia in association with elevated CTnI levels and IV salbutamol therapy, our local policy has been to screen/monitor patients on continuous IV salbutamol for cardiac ischaemia using blood CTnI levels. Here, we report our observations of CTnI levels in children treated with intravenous (IV) salbutamol for acute severe asthma.

This is a retrospective audit of routine clinical practice. The case mix comprises of children treated for acute severe asthma with IV salbutamol at the Leicester Royal Infirmary between September 2012 and April 2013. All children with severe asthma are managed in adjoining high dependency care or intensive care units. Patients with severe asthma were identified using ward admission databases.

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