DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20212468

A randomized controlled trial of nebulized epinephrine versus nebulized hypertonic saline in infants with acute bronchiolitis

Pradhyumn Pamecha, Sanjay Mandot

Abstract


Background: Acute Bronchiolitis is an infection of the lower respiratory tract, most frequently caused by the respiratory syncytial virus. It is one of the most common cause of hospital admission for respiratory tract illnesses in infants. This is a double blinded randomized controlled trial, conducted to compare the therapeutic efficacy of nebulized epinephrine versus nebulized hypertonic saline in infants with acute bronchiolitis.

Methods: It was a double blinded randomized controlled trial conducted over a period of 18 months (January 2019-June 2020) in infants aged 2 months to 1 year diagnosed with acute bronchiolitis. All eligible patients were randomly assigned to one of two groups: Group I received inhalation of Epinephrine; Group II received inhalation of Hypertonic (3%) Saline. Patients in each group received four treatments on each day of hospitalization, delivered at 6 hourly intervals. Monitoring parameters for improvement or worsening of the condition were measured and recorded on admission and then at 24 hourly intervals using the clinical score described by Wang, et al for the first three days of treatment.

Results: Among the infants treated with hypertonic saline, there was a significant decrease in the post inhalation respiratory score on day 2 and day 3 as compared to the infants treated with epinephrine. There was a significant difference in duration of hospitalization between the two groups as duration of hospitalization in infants was less in hypertonic saline group as compared to the epinephrine group. Hypertonic saline also showed significantly lesser side effects post inhalation when compared to epinephrine. The difference was statistically significant with p<0.0001.

Conclusions: The study concluded that the use of nebulized hypertonic saline in infants aged 2 months to 12 months, provides evidence for its role as an efficient treatment modality in the treatment of acute bronchiolitis. The study also found that nebulized epinephrine had more side effects associated with it.


Keywords


Acute bronchiolitis, Epinephrine, Hypertonic saline

Full Text:

PDF

References


Hall CB, Weinberg GA, Iwane MK, Blumkin AK, Edwards KM, Stat MA et al. The burden of respiratory syncytial virus infection in young children. New England Journal of Medicine. 2009;360(6):588-98.

Luo Z, Fu Z, Liu E, Xu X, Fu X, Peng D et al. Nebulized hypertonic saline treatment in hospitalized children with moderate to severe viral bronchiolitis. Clinical microbiology and infection. 2011;17(12):1829-33.

Kliegman RM. Nelson Textbook of Pediatrics: First South Asia Edition. 2015.

Guerguerian A-M, Gauthier M, Lebel MH, Farrell CA, Lacroix J. Ribavirin in ventilated respiratory syncytial virus bronchiolitis: a randomized, placebo-controlled trial. Am J RespirCrit Care Med. 1999;160:829-34.

Wheeler JG, Wofford JA, Turner RB. Historical cohort evaluation of ribavirin efficacy in respiratory syncytial virus infection. The Pediatric infectious disease journal. 1993;12(3):209-13.

Van Woensel JB, Wolfs TF, Van Aalderen WM, Brand PL, Kimpen JL. Randomised double blind placebo controlled trial of prednisolone in children admitted to hospital with respiratory syncytial virus bronchiolitis. Thorax. 1997;52(7):634-7.

Cade A, Brownlee KG, Conway SP, Haigh D, Short A, Brown J et al. Randomised placebo controlled trial of nebulised corticosteroids in acute respiratory syncytial viral bronchiolitis. Archives of disease in childhood. 2000;82(2):126-30.

Bertrand P, Araníbar H, Castro E, Sánchez I. Efficacy of nebulized epinephrine versus salbutamol in hospitalized infants with bronchiolitis. Pediatric pulmonology. 2001;31(4):284-8.

Patel H, Platt RW, Pekeles GS, Ducharme FM. A randomized, controlled trial of the effectiveness of nebulized therapy with epinephrine compared with albuterol and saline in infants hospitalized for acute viral bronchiolitis. The Journal of pediatrics. 2002;141(6):818-24.

Wainwright C, Altamirano L, Cheney M. A multicenter, randomized, double-blind, controlled trial of nebulized epinephrine in infants with acute bronchiolitis. N Engl J Med. 2003;349:27-35.

Tal G, Cesar K, Oron A, Houri S, Ballin A, Mandelberg A. Hypertonic saline/epinephrine treatment in hospitalized infants with viral bronchiolitis reduces hospitalization stay: 2 years experience. IMAJ-RAMAT GAN. 200;8(3):169.

Chin HJ, Seng QB. Reliability and validity of the respiratory score in the assessment of acute bronchiolitis. The Malaysian journal of medical sciences: MJMS. 2004;11(2):34.

Hanson IC, Shearer WT. Bronchiolitis. In: McMillan JA, Feigin RD, DeAngelis C, Jones MD, eds. Oski’s Pediatrics: Principles and Practice, 4th ed. Philadelphia: Lippincott Williams & Wilkins. 2006;1391.

Fjaerli HO, Farstad T, Bratlid D. Hospitalisations for respiratory syncytial virus bronchiolitis in Akershus, Norway, 1993–2000: a population-based retrospective study. BMC pediatrics. 2004;4(1):25.

Hervás D, Reina J, Yañez A, Del Valle JM, Figuerola J, Hervás JA. Epidemiology of hospitalization for acute bronchiolitis in children: differences between RSV and non-RSV bronchiolitis. European journal of clinical microbiology & infectious diseases. 2012;31(8):1975-81.

Nagayama Y, Tsubaki T, Nakayama S, Sawada K, Taguchi K, Tateno N et al. Gender analysis in acute bronchiolitis due to respiratory syncytial virus. Pediatric allergy and immunology. 2006;17(1):29-36.

Boezen HM, Jansen DF, Postma DS. Sex and gender differences in lung development and their clinical significance. Clin Chest Med. 2004;25:237-45.

Taneja V. Sex hormones determine immune response. Frontiers in immunology. 2018;9:1931.

Luo Z, Liu E, Luo J, Li S, Zeng F, Yang X et al. Nebulized hypertonic saline/salbutamol solution treatment in hospitalized children with mild to moderate bronchiolitis. Pediatrics International. 2010;52(2):199-202.

Mandelberg A, Tal G, Witzling M, Someck E, Houri S, Balin A et al. Nebulized 3% hypertonic saline solution treatment in hospitalized infants with viral bronchiolitis. Chest. 2003;123(2):481-7.

Patel H, Platt RW, Pekeles GS, Ducharme FM. A randomized, controlled trial of the effectiveness of nebulized therapy with epinephrine compared with albuterol and saline in infants hospitalized for acute viral bronchiolitis. The Journal of pediatrics. 2002;141(6):818-24.

Kuzik BA, Al Qadhi SA, Kent S, Flavin MP, Hopman W, Hotte S et al. Nebulized hypertonic saline in the treatment of viral bronchiolitis in infants. The Journal of pediatrics. 2007;151(3):266-70.

Ray MS, Singh V. Comparison of nebulized adrenaline versus salbutamol in wheeze associated respiratory tract infection in infants. Indian Pediatr. 2002;39(1):12-22.

Plint AC, Johnson DW, Patel H, Wiebe N, Correll R, Brant R, et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med. 2009;360:2079-89.

Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebulized hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev. 2008;4:CD006458.

Anil AB, Anil M, Saglam AB, Cetin N, Bal A, Aksu N. High volume normal saline alone is as effective as nebulized salbutamol‐normal saline, epinephrine‐normal saline, and 3% saline in mild bronchiolitis. Pediatric pulmonology. 2010;45(1):41-7.

Sarrell EM, Tal G, Witzling M, Someck E, Houri S, Cohen HA, Mandelberg A. Nebulized 3% hypertonic saline solution treatment in ambulatory children with viral bronchiolitis decreases symptoms. Chest. 2002;122(6):2015-20.