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A Randomized Trial of Nebulized Epinephrine vs Albuterol in the Emergency Department Treatment of Bronchiolitis
Colette C. Mull, MD;
Richard J. Scarfone, MD;
Lara R. Ferri, MD;
Teresa Carlin, MD;
Christy Salvaggio, MD;
Kirsten A. Bechtel, MD;
Mary Ann Hanes Trephan, MD;
Raquel L. Rissman, MD;
Edward J. Gracely, PhD
Arch Pediatr Adolesc Med. 2004;158:113-118.
Objective To determine if nebulized epinephrine is more efficacious than nebulized albuterol in the emergency department (ED) treatment of moderately ill infants with bronchiolitis.
Methods Sixty-six patients between 0 and 12 months of age with new-onset wheezing, an antecedent upper respiratory tract infection, and a clinical score (Respiratory Distress Assessment Instrument) of 8 to 15 were randomized in a double-blind fashion to receive either 0.9 mg/kg of nebulized 2.25% racemic epinephrine (n = 34) or 0.15 mg/kg of nebulized 0.5% albuterol sulfate (n = 32) at 0, 30, and 60 minutes.
Main Outcome Measures Primary outcome measures were clinical score and respiratory rate. Secondary outcome measures were room air oxygen saturation, elapsed time to meeting clinical criteria for ED discharge, hospitalization rate, and proportion of patients relapsed within 72 hours of ED discharge (relapse rate).
Results Both treatment groups experienced a similar pattern of change in mean clinical score, respiratory rate, and room air saturation over time. There were no significant differences between the groups by these same measures at any time. The median time at which infants were well enough for ED discharge was 90 minutes in the epinephrine-treated group vs 120 minutes in the albuterol-treated group (P = .01). Sixteen infants (47.1%) in the epinephrine-treated group were hospitalized compared with 12 infants (37.5%) in the albuterol-treated group (relative risk, 1.25; 95% confidence interval, 0.71-2.22). Relapse rate was 18.8% (3/16) in the epinephrine-treated group and 42.1% (8/19) in the albuterol-treated group (relative risk, 0.45; 95% confidence interval, 0.14-1.41). Adverse effects occurred infrequently.
Conclusions Although the patients treated with epinephrine were judged well enough for ED discharge significantly earlier than the patients treated with albuterol, epinephrine was not found to be more efficacious than albuterol in treating moderately ill infants with bronchiolitis.
From the Division of Emergency Medicine, Alfred I. duPont Hospital for Children, Wilmington, Del (Dr Mull); Emergency Department, Children ' s Hospital of Philadelphia, Philadelphia, Pa (Dr Scarfone); Division of Emergency Medicine, Children ' s Hospital, Boston, Mass (Dr Ferri); Department of Emergency Medicine, The Johns Hopkins University, Baltimore, Md (Dr Carlin); Section of Emergency Medicine, St Christopher ' s Hospital for Children, Philadelphia (Dr Salvaggio); Section of Emergency Medicine, Yale–New Haven Children ' s Hospital, New Haven, Conn (Dr Bechtel); Emergency Department, Kaiser Permanente Medical Group, Woodland Hills, Calif (Dr Hanes Trephan); Department of Pediatrics, Children ' s Hospital of Orange County (California), Orange (Dr Rissman); and the Department of Community and Preventive Medicine, Drexel University College of Medicine, Philadelphia (Dr Gracely).
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