Abstract
Acute bronchiolitis in infants, which frequently leads to hospitalization and sometimes requires ventilatory support, is occasionally fatal; it is usually viral in origin, with respiratory syncytial virus being the most common cause. The clinical disease is characterized by nasal flaring, tachypnea, dyspnea, chest retractions, crepitations, and wheezing.
Bronchodilators are not recommended but are often used in the treatment of bronchiolitis, as are saline inhalations. Adrenaline reduces mucosal swelling, giving it an edge over the β2-adrenergic agonists, and has led to the frequent use of inhaled adrenaline, which has improved symptoms and reduced the need for hospitalization in outpatients with acute bronchiolitis. Among inpatients, however, inhaled adrenaline has not been found to reduce the length of the hospital stay. Assessment of the possible influences of age, sex, and status with respect to an asthma predisposition on the effect of inhaled adrenaline requires large multicenter studies.
Inhaled nebulized solutions can be prescribed for use on demand or on a fixed schedule. We were unable to find documentation on the comparative efficacy of these two strategies in children with acute bronchiolitis.
We tested the hypothesis that inhaled racemic adrenaline is superior to inhaled saline in the treatment of acute bronchiolitis in infancy and that administration on a fixed schedule is superior to administration on demand. We also assessed whether age, sex, or status with respect to allergic diseases influenced treatment efficacy.
Including: Letter to the Editor. Skjerven Håvard Ove, Carlsen Kai-Håkon og Carlsen Karin C Lødrup. Inhaled adrenaline in acute bronchiolitis. The New England Journal of Medicine 2013;369:1076-7. http://dx.doi.org/10.1056/NEJMc1308964