Wainwright C, Altamirano L, Cheney M, et al. N Engl J Med. 2003;349:27–35
Purpose of the Study.
To explore the role of racemic epinephrine, administered via inhalation, in acute bronchiolitis.
Infants with corrected ages of <12 months who were admitted for a first episode of wheezing were studied. A clinical diagnosis of bronchiolitis was required, with upper respiratory congestion and evidence of turbulent airflow in the lower airway.
Standard therapy, including hydration, oxygen administration, and upper airway suctioning, was administered to all patients. Treatment with a Jet nebulizer, driven with 6 L/minute oxygen, was used for 3 doses of 4 mg of epinephrine or placebo. Measurement of oxygen saturation, heart rate, and respiratory score was performed before and after treatment.
There was no statistical difference between the groups with respect to time to readiness for discharge, as defined by no oxygen requirement for 10 hours, good hydration, and no retractions. A requirement for supplemental oxygen was the strongest predictor of disease severity and length of hospitalization. Increased heart rate after epinephrine treatment (20 beats/minute) was observed for the treatment group but there were no changes in respiratory rates, blood pressure, or respiratory effort scores.
The use of nebulized epinephrine did not reduce the time to readiness for discharge among infants with bronchiolitis.
These results support a recent meta analysis. A recent study suggested that the use of 3% normal saline with 1.5 mg of epinephrine, administered via inhalation, was superior to the use of 0.9% normal saline with 1.5 mg of epinephrine. The burden of evidence continues to indicate that supportive therapy, with good hydration, upper airway suctioning, and oxygen administration, is the most important intervention strategy for acute viral bronchiolitis. A trial of inhalation therapy with epinephrine or albuterol could be supported if responses were observed and continued; if not, the trial should be discontinued.