In view of the effectiveness and relative safety of rapidacting 2-agonists, theophylline has a minimal role in the management of acute asthma. Its use is associated with severe and potentially fatal side effects, particularly in those on long-term therapy with slow-release theophylline, and its bronchodilator effect is less than that of 2-agonists. In one study of children with near-fatal asthma, intravenous theophylline provided additional benefit to patients also receiving an aggressive regimen of inhaled and intravenous 2-agonists, inhaled ipatropium bromide, and intravenous systemic glucocorticosteroids. Intravenous magnesium sulphate has not been studied in children 5 years and younger. An oral glucocorticosteroid dose of 1 mg/kg daily is adequate for treatment of exacerbations in children with mild.
