The Clinical Efficacy of Nebulized Racemic Epinephrine and Albuterol in Acute Bronchiolitis

A prospective randomized controlled blinded study of three bronchodilators in infants with respiratory syncytial virus bronchiolitis on mechanical ventilation*

“…However, the change in PIP and change in Rrs after treatment were only weakly correlated even though the correlation was statistically significant (r ϭ 0.36 and p Ͻ 0.001 for the correlation between the change in PIP and the Because the pathophysiology of airways obstruction in RSV bronchiolitis includes submucosal edema as well as inadequate clearance of secretions and dense alveolar debris, epinephrine might be expected to demonstrate some benefit because of mobilization of edema. In seven previous studies of epinephrine (22)(23)(24)(25)(26)(27)(28) administered by various routes, doses, and conditions, all showed some improvement by various clinical and airway flow measures. We found the benefit of epinephrine at 20 mins to be modest, as one might anticipate since the airways obstruction is due not only to edema and bronchoconstriction, but intraluminal mucous and debris as well as a variety of proinflammatory mediators, histamine, eosinophilic catatonic proteins, altered balance of adrenergic and cholinergic control of the airways and increased acetylcholine at the myoneural junction.…”

A Randomized Trial of Nebulized Epinephrine vs Albuterol in the Emergency Department Treatment of Bronchiolitis

“…[5][6][7][8][9] Its internal validity was established previously 8 and excellent interobserver reliability with the RDAI has been reported by ourselves as well as other investigators in this field of study. 5,6,8,9 An alternative means of clinical assessment would have been to perform pulmonary function testing in sedated subjects. This would have been technically difficult and the results would not have been generalizable to the ED.…”

Salbutamol safety in children under 2 years of age with acute wheezing: a meta-analysis of randomised controlled trials

“…Dosing schedule differed in the included works ranging from one administration per day to hourly administration, as detailed in table 1. Seven studies compared salbutamol to epinephrine,17–23 two to ipratropium bromide24 25 and one to magnesium sulfate 26. In eight studies, multiple comparison groups with different drugs, salbutamol dosages and additional treatments, such as hypertonic saline 3%, were present.…”