Racemic epinephrine compared to salbutamol in hospitalized young children with bronchiolitis; a randomized controlled clinical trial [ISRCTN46561076].
BACKGROUND
Bronchiolitis is the most common cause of lower respiratory tract illness in infancy, and hospital admission rates appear to be increasing in Canada and the United States. Inhaled beta agonists offer only modest short-term improvement. Trials of racemic epinephrine have shown conflicting results. We sought to determine if administration of racemic epinephrine during hospital stay for bronchiolitis improved respiratory distress, was safe, and shortened length of stay.


METHODS
The study was a randomized, double-blind controlled trial of aerosolized racemic epinephrine compared to salbutamol every one to 4 hours in previously well children aged 6 weeks to < or = 2 years of age hospitalized with bronchiolitis. The primary outcome was symptom improvement as measured by the Respiratory Distress Assessment Instrument (RDAI); secondary outcomes were length of stay in hospital, adverse events, and report of symptoms by structured parental telephone interview one week after discharge.


RESULTS
62 children with a mean age of 6.4 months were enrolled; 80% of children had Respiratory Syncytial Virus (RSV). Racemic epinephrine resulted in significant improvement in wheezing and the total RDAI score on day 2 and over the entire stay (p < 0.05). The mean LOS in the epinephrine arm was 2.6 days (95% CI 2, 3.2) v. 3.4 days in those in the salbutamol group (95% CI 2.6, 4.2) (p > 0.05). Adverse events were not significantly different in the two arms. At one week post-discharge, over half of parents reported that their child still had a respiratory symptom and 40% had less than normal feeding.


CONCLUSIONS
Racemic epinephrine relieves respiratory distress in hospitalized infants with bronchiolitis and is safe but does not abbreviate hospital stay. Morbidity associated with bronchiolitis as identified by parents persists for at least one week after hospital discharge in most infants.
Langley
Joanne M
JM
Clinical Trials Research Centre, Dalhousie University, Halifax, Canada. joanne.langley@dal.ca
Smith
Michael B
MB
LeBlanc
John C
JC
Joudrey
Heather
H
Ojah
Cecil R
CR
Pianosi
Paul
P
D000280:Administration, Inhalation; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use*; D001988:Bronchiolitis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002675:Child, Preschool; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D064705:Racepinephrine; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy*; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification; D012720:Severity of Illness Index; D013237:Stereoisomerism; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D064705:Racepinephrine; D000420:Albuterol; D004837:Epinephrine