Abstract
BackgroundBronchiolitis 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.MethodsThe 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 ≤ 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.Results62 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.ConclusionRacemic 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.
Highlights
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
While there is evidence that acute symptoms of bronchiolitis measured in the short term may improve with epinephrine, these reviews have called for more studies assessing longer-term outcomes such as duration of stay, and that are clinically relevant to parents, clinicians and the health care system
We report a randomised controlled trial of aerosolised epinephrine compared to salbutamol throughout hospital stay in infants with bronchiolitis to assess daily clinical improvement, length of hospital stay and adverse events, and outcomes by parental report one week after discharge to the community
Summary
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. The incidence of hospitalisation for bronchiolitis in infancy has increased in both the United States [3] and Canada [4] in the last two decades, and a 100% increase in first time hospitalisation for lower respiratory tract illness in children under two years has been noted in northern Europe [5]. A systematic review of randomised clinical trials of the efficacy of beta-agonist aerosols suggests they offer only modest short term improvement [6]. While there is evidence that acute symptoms of bronchiolitis measured in the short term may improve with epinephrine, these reviews have called for more studies assessing longer-term outcomes such as duration of stay, and that are clinically relevant to parents, clinicians and the health care system
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