Racemic Adrenaline in Acute Bronchiolitis

Posted by • June 14th, 2013

In this study of infants with bronchiolitis, there was no difference in the length of hospital stay between those treated with inhaled adrenaline and those treated with inhaled saline. Infants treated on demand had a shorter length of stay than those treated on a fixed schedule.

Acute bronchiolitis in infants frequently results in hospitalization, but there is no established consensus on inhalation therapy – either the type of medication or the frequency of administration.

Clinical Pearls

 What is the usual etiology and clinical manifestations of acute bronchiolitis in infants?

Acute bronchiolitis in infants, which frequently leads to hospitalization and sometimes requires ventilatory support, is occasionally fatal; it is usually viral in origin, with respiratory syncytial virus being the most common cause. The clinical disease is characterized by nasal flaring, tachypnea, dyspnea, chest recessions, crepitations, and wheezing.

• How is bronchiolitis in infants typically managed?

Bronchodilators are not recommended but are often used in the treatment of bronchiolitis, as are saline inhalations. Adrenaline reduces mucosal swelling, giving it an edge over the (beta)2-adrenergic agonists, and has led to the frequent use of inhaled adrenaline, which has improved symptoms and reduced the need for hospitalization in outpatients with acute bronchiolitis. Among inpatients, however, inhaled adrenaline has not been found to reduce the length of the hospital stay. Glucocorticoids are not recommended.

Morning Report Questions

Q: What were the study results comparing the use of inhaled racemic adrenaline versus inhaled saline?

A: There was no significant difference in length of hospital stay between children treated with inhaled racemic adrenaline and those treated with inhaled saline (P=0.43). There were also no significant between-group differences in the use of nasogastric-tube feeding, supplementary oxygen, or ventilatory support; clinical scores before and after the first inhalation of the study medication; or the number of children in whom the study medication was discontinued.

Table 2. Length of Stay and Use of Supportive Therapy According to Medication and Inhalation Strategy.

Q: What did the analysis of on-demand versus fixed-schedule dosing of racemic adrenaline demonstrate?

A: The mean length of the hospital stay was significantly shorter for children in the group receiving treatment on demand than in the group receiving treatment on a fixed schedule (P=0.01). Children in the on-demand group received a mean of 5.0 (30%) fewer inhalations than those in the fixed-schedule group (P<0.001). Children receiving inhalations on demand also had a lower probability of being treated with ventilatory support (P=0.01) or supplementary oxygen (P=0.04), and inhalations given on demand were not associated with nasogastric-tube feeding or treatment discontinuation.

Table 2. Length of Stay and Use of Supportive Therapy According to Medication and Inhalation Strategy.


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