Nebulized epinephrine does not help bronchiolitis

,; Stevermer, James

Q&A

Nebulized epinephrine does not help bronchiolitis

J Fam Pract. 2003 November;52(11):828-848

By

Shamita Misra, MD

James J. Stevermer, MD, MSPH

BACKGROUND: Bronchiolitis is a common viral infection of the lower respiratory tract, accounting for hospitalization of approximately 1% of healthy infants. Because of bronchiolar swelling, the use of bronchodilators and anti-inflammatory agents makes sense in managing bronchiolitis. However, steroids have not shown clear evidence of benefit, and studies of epinephrine have had mixed results.
POPULATION STUDIED: Infants (aged <1 year) were enrolled if they were admitted to any of 4 Queensland, Australia, hospitals with bronchiolitis. The diagnosis of bronchiolitis was made based on history and clinical findings consistent with bronchiolitis, including wheezing with or without crackles and respiratory distress with retractions.
STUDY DESIGN AND VALIDITY: This was a multicenter, randomized, double blind, placebo-controlled study. Allocation appears to have been adequately concealed. Patients were randomly assigned to receive three doses of nebulized epinephrine 1% solution or placebo at 4-hour intervals within 24 hours after their admission to the hospital.
OUTCOMES MEASURED: The 2 primary outcomes were the length of the hospital stay and the time until the infant was ready for discharge. The second time was defined by a criterion standard, and may more accurately reflect the clinical response, as other factors—such as transportation—might affect the actual time of discharge.
RESULTS: The groups were essentially equal at study entry. Treatment with epinephrine, compared with placebo, had no significant effect on the length of the hospital stay (58.4 vs 69.5 hours) or the time until the infant was ready for discharge (46.5 vs 47.7 hours). There was no significant difference between the groups in the time receiving supplemental oxygen or in the rates of intensive care or ventilatory support. In those patients who required both oxygen and intravenous fluids, the use of epinephrine appeared to prolong the time until ready for discharge (135.9 vs 80.2 hours; P=.02).

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Nebulized epinephrine does not help bronchiolitis

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