Related Experiment Video
Updated: May 31, 2026
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
Epinephrine for bronchiolitis
Lisa Hartling1, Liza M Bialy, Ben Vandermeer
1Department of Pediatrics, University of Alberta, Aberhart Centre One, Room 9424, 11402 University Avenue, Edmonton, Alberta, Canada, T6G 2J3.
Insights
Epinephrine effectively reduces short-term hospital admissions for young children with acute viral bronchiolitis, especially within 24 hours. Combined epinephrine and steroid therapy may offer later benefits, warranting further research.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Evidence-Based Medicine
Background:
- Bronchodilators are frequently used for acute bronchiolitis in children, but their effectiveness is not well-established.
- Acute viral bronchiolitis is a common respiratory illness in infants and young children.
Purpose of the Study:
- To evaluate the efficacy and safety of epinephrine in treating acute viral bronchiolitis in children under two years old.
- To compare epinephrine with placebo and other bronchodilators for pediatric bronchiolitis.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) identified through comprehensive database searches.
- Inclusion criteria focused on children under two with acute viral bronchiolitis, comparing epinephrine to placebo or other interventions.
- Primary outcomes included admission rates and length of stay; secondary outcomes covered clinical severity, symptoms, and adverse events.
Main Results:
- Epinephrine significantly reduced Day 1 admissions for outpatients compared to placebo, but not Day 7 admissions.
- Inpatients receiving epinephrine had a shorter length of stay compared to salbutamol.
- Combined epinephrine and steroid therapy showed a reduced Day 7 admission rate versus placebo in one RCT; no significant adverse events were noted.
Conclusions:
- Epinephrine demonstrates superiority over placebo for short-term outcomes in outpatients with acute bronchiolitis.
- Evidence suggests potential benefits of combined epinephrine and steroid therapy for later outcomes, requiring further investigation.
- Current evidence does not support the effectiveness of repeated or prolonged use of epinephrine or combined epinephrine and dexamethasone in inpatients.
Background:
Bronchodilators are commonly used for acute bronchiolitis, despite uncertain effectiveness.
Objectives:
To examine the efficacy and safety of epinephrine in children less than two with acute viral bronchiolitis.
Search Strategy:
We searched CENTRAL (2010, Issue 3) which contains the Acute Respiratory Infections Group's Specialized Register, MEDLINE (1950 to September Week 2, 2010), EMBASE (1980 to September 2010), Scopus (1823 to September 2010), PubMed (March 2010), LILACS (1985 to September 2010) and Iran MedEx (1998 to September 2010).
Selection Criteria:
We included randomized controlled trials comparing epinephrine to placebo or another intervention involving children less than two years with acute viral bronchiolitis. Studies were included if the trials presented data for at least one quantitative outcome of interest.We selected primary outcomes a priori, based on clinical relevance: rate of admission by days one and seven of presentation for outpatients, and length of stay (LOS) for inpatients. Secondary outcomes included clinical severity scores, pulmonary function, symptoms, quality of life and adverse events.
Data Collection And Analysis:
Two review authors independently screened the searches, applied inclusion criteria, assessed risk of bias and graded the evidence. We conducted separate analyses for different comparison groups (placebo, non-epinephrine bronchodilators, glucocorticoids) and for clinical setting (inpatient, outpatient).
Main Results:
We included 19 studies (2256 participants). Epinephrine versus placebo among outpatients showed a significant reduction in admissions at Day 1 (risk ratio (RR) 0.67; 95% confidence interval (CI) 0.50 to 0.89) but not at Day 7 post-emergency department visit. There was no difference in LOS for inpatients. Epinephrine versus salbutamol showed no differences among outpatients for admissions at Day 1 or 7. Inpatients receiving epinephrine had a significantly shorter LOS compared to salbutamol (mean difference -0.28; 95% CI -0.46 to -0.09). One large RCT showed a significantly shorter admission rate at Day 7 for epinephrine and steroid combined versus placebo (RR 0.65; 95% CI 0.44 to 0.95). There were no important differences in adverse events.
Authors' Conclusions:
This review demonstrates the superiority of epinephrine compared to placebo for short-term outcomes for outpatients, particularly in the first 24 hours of care. Exploratory evidence from a single study suggests benefits of epinephrine and steroid combined for later time points. More research is required to confirm the benefits of combined epinephrine and steroids among outpatients. There is no evidence of effectiveness for repeated dose or prolonged use of epinephrine or epinephrine and dexamethasone combined among inpatients.
Related Concept Videos
01:30Adrenergic Agonists: Therapeutic Uses
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and anaphylaxis:...
01:25Antiasthma Drugs: β2-Adrenoceptor Agonists
One class of bronchodilators includes β2-adrenoceptor agonists. These agents target the β2-adrenoceptors located on bronchial smooth muscle cells. By stimulating these receptors, β2-agonists induce relaxation in these...
01:18Adrenergic Agonists: Therapeutic Classification
Vasopressor or pressor agents: They increase blood pressure and function as cardiac stimulants. Examples include endogenous catecholamines (norepinephrine and dopamine) and synthetic agents (phenylephrine).
Bronchodilators: β2-agonists can relax bronchial muscles and widen airways. They are commonly used for treating obstructive pulmonary...
01:17Drugs Used in Lower Respiratory Disorders: Overview
Bronchodilators, the first step of respiration enhancement, come in various forms, each with its own mechanism...
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:28Adrenergic Agonists: Mixed-Action Agents
Ephedrine and pseudoephedrine lack a catecholamine group, making them less susceptible to degradation by metabolic enzymes. They have increased oral bioavailability and lipophilicity, resulting in a longer duration of action. Their response is reduced by...