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Comparison of nebulized epinephrine to albuterol in bronchiolitis
Paul Walsh1, John Caldwell, Kemedy K McQuillan
1Department of Emergency Medicine, Kern Medical Center, Bakersfield, CA, USA. yousentwhohome@gmail.com
Insights
Nebulized racemic albuterol improved successful discharge rates for infants with bronchiolitis compared to racemic epinephrine. This finding supports albuterol as a preferred treatment for emergency department care.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Illnesses
- Pharmacology
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Treatment options for bronchiolitis in the emergency department (ED) are limited.
- Racemic epinephrine and albuterol are commonly used bronchodilators.
Purpose of the Study:
- To compare the efficacy of nebulized racemic epinephrine versus racemic albuterol in achieving successful discharge from the ED for infants with bronchiolitis.
- To evaluate the impact of these treatments on subsequent hospital admission rates.
Main Methods:
- A double-blind randomized controlled trial (RCT) involving 703 infants up to 18 months old diagnosed with bronchiolitis.
- Participants received either racemic albuterol or racemic epinephrine.
- Successful discharge was defined as no additional bronchodilators needed in the ED and no admission within 72 hours.
Main Results:
- Patients receiving racemic albuterol had a higher rate of successful discharge compared to those receiving racemic epinephrine (adjusted relative risk [aRR] = 1.18).
- This difference was statistically significant (95% confidence interval [CI] = 1.02 to 1.36).
- The benefit of albuterol was also observed in infants under 12 months and those presenting for the first time.
Conclusions:
- Nebulized racemic albuterol is more effective than racemic epinephrine in promoting successful discharge for infants with bronchiolitis treated in the emergency department.
- Albuterol may be a preferred bronchodilator for managing bronchiolitis in this age group.
Objectives:
To compare the effect of nebulized racemic epinephrine to nebulized racemic albuterol on successful discharge from the emergency department (ED).
Methods:
Children up to their 18th month of life presenting to two teaching hospital EDs with a clinical diagnosis of bronchiolitis who were ill enough to warrant treatment but did not need immediate intubation were eligible for this double-blind randomized controlled trial (RCT). Patients received either three doses of racemic albuterol or one dose of racemic epinephrine plus two saline nebulizers. Disposition was decided 2 hours after the first nebulizer. Successful discharge was defined as not requiring additional bronchodilators in the ED after study drug administration and not subsequently admitted within 72 hours. Adjusted relative risks (aRR) were estimated using the modified Poisson regression with successful discharge as the dependent variable and study drug and severity of illness as exposures. Secondary analysis was performed for patients aged less than 12 months and first presentation.
Results:
The authors analyzed 703 patients; 352 patients were given albuterol and 351 epinephrine. A total of 173 in the albuterol group and 160 in the epinephrine group were successfully discharged (crude RR = 1.08, 95% confidence interval [CI] = 0.92 to 1.26). When adjusted for severity of illness, patients who received albuterol were significantly more likely than patients receiving epinephrine to be successfully discharged (aRR = 1.18, 95% CI = 1.02 to 1.36). This was also true among those with first presentation and in those less than 12 months of age.
Conclusions:
In children up to the 18th month of life, ED treatment of bronchiolitis with nebulized racemic albuterol led to more successful discharges than nebulized epinephrine.
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