Epinephrine for bronchiolitis. Cochrane Database of Systematic Reviews

2011,Issue 6. Art. No.: CD003123. DOI: 10.1002/14651858.CD003123.pub3. Accessed October 27, 2011.Hartling L, Bialy LM, Vandermeer B, et al.

Link to article:  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003123.pub3/pdf

Article Review:

Hartling et al reviewed 19 publications that collectively investigated more than 2,200 infants with bronchiolitis. The studies focused on therapies for outpatients and inpatients, but excluded severe cases requiring ICU admission and intubation.  Two main clinical factors were evaluated: rate of admission on day 1 and day 7 of presentation, and length of stay (LOS) for inpatients on the pediatric ward. Secondary outcomes studied included respiratory rate, retractions, oxygen saturation, heart rate, rate of readmission, pulmonary function tests, adverse events, and quality of life.

Overall, their findings showed that when administered to infants upon early presentation with bronchiolitis, inhaled epinephrine greatly reduced the likelihood of hospitalization.

Highlights of the review:

• Inhaled epinephrine versus placebo among outpatients showed a significant reduction in admission rates at Day 1, but not at Day 7 of illness.
• Repeated dosing of inhaled epinephrine offered no increased benefit over a single dose.
• Epinephrine markedly decreased the length of hospital stay when compared with salbutamol.
• There were no adverse effects seen with short-term use of epinephrine.
• One study suggested benefits of epinephrine and dexamethasone in reducing outpatient admissions.
• More research is needed to confirm if steroids combined with epinephrine are beneficial.

Epinephrine showed a significant reduction in length of hospital stay as compared to salbutamol. But a confounding finding demonstrated no differences in length of stay for epinephrine versus placebo.

 

 

Reviewer’s commentary

Bronchiolitis is a common reason for infant hospitalization during the winter months. While bronchodilators such as albuterol are routinely used, there is no clear evidence that this intervention is effective.

This review demonstrates the effectiveness in reducing hospitalization rates in infants with bronchiolitis who received inhaled epinephrine upon presentation in the outpatient setting. If an infant presents to the outpatient setting with clinical signs of bronchiolitis, inhaled epinephrine should be considered.  If their respiratory status and general state of health are favorable following this treatment, the infant can be safely sent home if close follow-up is arranged.