The Clinical Efficacy of Nebulized Racemic Epinephrine and Albuterol in Acute Bronchiolitis

doi:10.1001/archpedi.1995.02170190096017

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Vol. 149 No. 6, June 1995

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The Clinical Efficacy of Nebulized Racemic Epinephrine and Albuterol in Acute Bronchiolitis

Tiina Reijonen, MD; Matti Korppi, MD; Sirpa Pitkäkangas, MD; Sirpa Tenhola, MD; Kyllikki Remes, MD

Arch Pediatr Adolesc Med. 1995;149(6):686-692.

Abstract

Objective
To investigate whether nebulized racemic epinephrine or albuterolimproves respiratory distress in infants with acute bronchiolitis.

Design
A randomized, placebo-controlled, double-blind study.

Setting
A university hospital providing primary hospital care for allpediatric patients in a defined area.

Patients
One hundred consecutive infants younger than 24 months treatedin the hospital for acute bronchiolitis.

Intervention
The patients received two inhalations at 30-minute intervals:racemic epinephrine followed by physiologic saline (REP group;n=24), albuterol followed by physiologic saline (AP group; n=27),physiologic saline followed by racemic epinephrine (PRE group;n=24), and physiologic saline followed by albuterol (PA group;n=25). All patients received intramuscular epinephrine 60 minutesafter the beginning of the study.

Main Outcome Measures
Oxygen saturation, respiratory rate, and two clinical scoreswere used: one based on wheezing and retractions (RespiratoryDistress Assessment Instrument) and the other based on changesin wheezing, retractions, and respiratory rate (RespiratoryAssessment Change Score).

Main Results
During the study, there were no significant differences amongthe four groups in clinical scores, oxygen saturations, andrespiratory rates. Mean Respiratory Distress Assessment Instrumentscores improved significantly within the REP, PRE, and AP groups15 minutes after the first inhalation. In only the REP group,which received racemic epinephrine, the confidence limits didnot overlap. A comparison of paired data of each patient revealedthat the difference in Respiratory Assessment Change Score wassignificant between racemic epinephrine and physiologic saline,but not between albuterol and physiologic saline. Intramuscularepinephrine significantly improved Respiratory Distress AssessmentIndex scores in those groups treated earlier with racemic epinephrine(REP and PRE groups). No significant adverse effects were seenin any group or at any phase of the study.

Conclusions
Elimination of hypoxia by supplemental oxygen and moisteningof inspired air relieve the symptoms of acute bronchiolitis.Nebulized racemic epinephrine and albuterol are safe and usefulin the treatment of acute bronchiolitis. Improvements in symptomscores at 15 minutes favor the use of racemic epinephrine. Asthe action of epinephrine is short, the effect can be increasedby repeated inhalations.

(Arch Pediatr Adolesc Med. 1995;149:686-692)

Author Affiliations

From the Department of Pediatrics, Kuopio (Finland) University Hospital.

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