Rational drug use for acute bronchiolitis in emergency care

Abstract

Despite the large variety of inhaled treatment options of acute bronchiolitis, there is no generally agreed treatment regime. This study aimed to determine the most appropriate treatment option. This was a double-blind randomized prospective clinical trial and has been performed in emergency department. The mean age of the 378 infants included in the study was 7.63 ± 4.6 months, and 54.8% (207) were boys. Patients were randomized by using the lottery method for simple random sample into 5 different treatment options; 3% hypertonic saline, nebulized adrenaline, nebulized adrenaline mixed with 3% hypertonic saline, nebulized salbutamol, and as control group; normal saline (0.9% NaCl). From the first treatment time until discharge time; treatment durations, adverse events and readmission rates within the first fifteen days were recorded for each patient. Nebulized adrenaline mixed with 3% hypertonic saline, as compared with other options, were associated with a significantly higher discharge rate at 4 th hours (p<0.001) and shorter length of hospital stay (p=0.039). However, there was no significant difference between options with regard to adverse events, discharge rates at 24 th hours, and readmission rates within the first fifteen days. The superiority of discharge rates at 4 hours of nebulized adrenaline mixed with 3% hypertonic saline, was evaluated as 'better acute response' and can be helpful to reduce hospitalization needs. Additionally, this option seems to be more effective to reduce length of hospital stay.

Nebulization of epinephrine to reduce the severity of brachycephalic obstructive airway syndrome in dogs

“…No side effects requiring intervention were observed in any of the preoperative cohort. This supports the hypothesis that epinephrine nebulization is an intervention with minimal side effects, as has already been documented in the human literature 10,12,16‐17 . The main side effect was nausea, which may have been induced by stress associated with nebulization or, alternatively, may have been a side effect of the epinephrine itself.…”

“…This supports the hypothesis that epinephrine nebulization is an intervention with minimal side effects, as has already been documented in the human literature. 10,12,[16][17] The main side effect was nausea, which may have been induced by stress associated with nebulization or, alternatively, may have been a side effect of the epinephrine itself. Most dogs that became nauseous were known to regurgitate previously, attributed to their BOAS; however, one dog that became nauseous had no history of regurgitation, so the side effect in this dog was likely directly related to nebulization.…”

“…2 The use of nebulized epinephrine in man is associated with low morbidity; reported side effects include mild increases in heart rate, pallor, and, occasionally, tremors or nausea. 10,12,[16][17] Despite the widespread use of nebulized epinephrine, only one instance of a major complication has been reported, in which the patient developed ventricular tachycardia after nebulization. 18 To the best of the authors' knowledge, there are no reports in the veterinary literature describing the side effects of nebulized epinephrine in dogs.…”

Comparison of Epinephrine and Salbutamol Nebulization in Acute Bronchiolitis in terms of mean change in RDAI Score

“…11 A randomized double-blind trial from Turkey showed no statistical difference between nebulized epinephrine and salbutamol in terms of discharge rate at 24 hours, however adrenaline with 3% hypertonic helped reduce the length of stay (p=0.039). 12 Racemic epinephrine was compared with hypertonic saline in terms of length of stay by Yasin F et al 13 and found epinephrine effective in reducing the length of stay in patients with moderate bronchiolitis. However, some contrasting results were also in literature, where researchers demonstrated equal effectiveness of salbutamol and epinephrine.…”

Effects of nebulized epinephrine in association with hypertonic saline for infants with acute bronchiolitis: A systematic review and meta‐analysis

“…We decided not to carry out a metaanalysis of safety data due to a small number of events and show a very low rate of mild adverse events during or post nebulization (1%) and no patient was withdrawn from the study due to side effects. One trial 23 reported a total frequency of 5.5% of adverse events (including tachycardia, pallor, tremor, nausea, and vomiting), but rates were not significantly different when comparing intervention and control groups. Pandit et al 38 reported four mild events (4%) in the 0.9% saline plus epinephrine group (three vomiting and one diarrhea).…”