Comparative Efficacy of Nebulized L-adrenaline versus Salbutamol in Infants with Acute Bronchiolitis

Abstract

Background: Bronchiolitis is one of the most prevalent diseases of infancy for which large number of infants need hospitalization, particularly during winter period. RSV (Respiratory syncitial virus) is the principal causative pathogenic organism. Reliving symptoms are the main aim of management though none of the treatment modalities is specific. Bronchodilators like salbutamol, adrenaline, anti-cholinergic drugs, ipratropium bromide and saline nebulization have been used with varying results.Methods: This prospective study included 52 infants (2-12 months, male:female ratio 2:1) with bronchiolitis (with 1st episode of wheeze, previously healthy baby, physical findings with cough, running nose, fever, coryza and inflation of lungs) to understand comparative efficacy of nebulized salbutamol with adrenaline in bronchiolitis. The cases were randomized into nebulized salbutamol group (n=25) and nebulized adrenaline group (n=27). After randomization three nebulization were given at the interval of 20 minutes. Outcome of therapy was evaluated by respiratory rate, MRDAI (Modified Respiratory Distress Assessment Instrument) score and O2 saturation before and after therapy.Results: Study cases in both the groups presented with cough (100%), respiratory distress (100%), feeding difficulty (90.3%), running nose (98%) and wheeze (100%). Majority of the cases live in urban area and mostly from non-smoker family. In salbutamol group respiratory rate, MRDAI score and O2 saturation (before nebulization RR-67.5±6.1, MRDAI score-14.6±1.3, SaO2 93.9±1.6 and after nebulization RR- 52.5±4.9, MRDAI score-6.4±1.7, SaO2-97.1±1.5) significantly improved after 3 nebulizations. In adrenaline group respiratory rate, MRDAI score and O2 saturation (before nebulization RR-64.9±5.9, MRDAI score-15.0±0.8, SaO2-94.1±1.4 and after nebulization RR-50.0±2.9, MRDAI score-7.7±1.0, SaO2-97.9±1.5) also significantly improved after 3 nebulizations. Improvement was more significant in adrenaline group. Heart rate in both groups were increased (salbutmol group-151.8±10.6 and in adrenaline group-160.2±10.1) but more in adrenaline group. When comparative efficacy evaluated, it was observed that nebulized adrenaline therapy was significantly superior to nebulized salbutamol therapy in reliving symptoms (p=.004).Conclusion: The study concluded that both nebulized salbutamol and l-adrenaline are effective and nebulized l- adrenaline is significantly superior to nebulized salbutamol in infant with bronchiolitis in reliving symptom. Key words: Nebulized l-adrenaline; nebulized salbutamol; acute bronchiolitis. DOI: 10.3329/bjch.v32i1.6007 Bangladesh Journal of Child Health 2008; Vol.32(1): 10-16