title: Randomized, placebo-controlled trial of albuterol and epinephrine at equipotent beta-2 agonist doses in acute bronchiolitis.
abstract: Our objective was to determine if nebulized racemic epinephrine is more efficacious than nebulized albuterol or saline placebo in the treatment of bronchiolitis in the outpatient setting when dosing is equivalent in terms of beta-2 agonist potency. Sixty-five patients between ages 6 weeks and 24 months with a diagnosis of bronchiolitis, defined as first-time wheezing, upper respiratory symptoms and/or fever, and a Respiratory Distress Assessment Instrument score of at least 4, were randomized to receive 5 mg nebulized albuterol, 5 mg nebulized racemic epinephrine, or an equivalent volume of placebo at 0, 30, and 60 min. The primary outcome measure was need for hospital admission or home oxygen. Secondary outcome measures were changes in clinical scores and oxygen saturations. There were no significant statistical differences between groups in terms of need for hospital admission or outpatient management with home oxygen therapy. There were no differences between groups in terms of changes in clinical scores or oxygen saturations. Racemic epinephrine and albuterol at equivalent doses had no effect on the need for hospitalization or supplemental oxygen in bronchiolitis in the outpatient setting compared to nebulized saline placebo, though this study may have missed less dramatic clinical effects due to small sample size.
authors.affiliation: Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA. sralston@salud.unm.edu
authors.forename: Shawn
authors.initials: S
authors.lastname: Ralston
authors.forename: Carol
authors.initials: C
authors.lastname: Hartenberger
authors.forename: Theresa
authors.initials: T
authors.lastname: Anaya
authors.forename: Clifford
authors.initials: C
authors.lastname: Qualls
authors.forename: H William
authors.initials: HW
authors.lastname: Kelly
mesh_terms: D000208:Acute Disease; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D000420:Albuterol / Q000008:administration & dosage*; D001988:Bronchiolitis / Q000188:drug therapy*; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D009330:Nebulizers and Vaporizers; D010102:Oxygen Inhalation Therapy; D064705:Racepinephrine; D016896:Treatment Outcome
chemical_list: D000318:Adrenergic beta-Agonists; D064705:Racepinephrine; D000420:Albuterol; D004837:Epinephrine