Effect of treatment with subcutaneous epinephrine versus nebulized salbutamol on O2 saturation and rate of admission in patients with bronchiolitis

Abstract

Despite wide spread use of epinephrine β2-agonists in infants with bronchiolitis since the late
1950s, the efficacy of these drugs remains unproven. The objective of the study is to determine
the effective treatment with subcutaneous (s.c) epinephrine versus nebulized salbutamol on O2
saturation and rate of admission to hospital in patients (age 2 years or less) with bronchiolitis.
Single dose of epinephrine (0.01 mg/kg) has been used across various age groups of 2 years or
less (maximum dose used was 0.15 mg) and no complications were reported suggesting that
the dose is safe; however, the maximum safe dose cannot be interpreted from this study. The
response to sc epinephrine in patients younger than 12 months was significantly better than in
older patients, suggesting a useful role of s.c epinephrine in bronchiolitis in this age. The s.c
epinephrine relieves clinical manifestations of respiratory distress (wheezing, chest retractions,
flaring of alanasi, cyanosis) and improves parameters of respiratory distress (oxygen saturation,
respiratory rate) in infants treated for acute bronchiolitis with maximal effectiveness at 30-60
minute. For s.c epinephrine, every patient had his own disposable syringe; while for nebulized
salbutamol, all patients share the same nebulizer. So that, s.c epinephrine may decrease the
likelihood of transmission of infection between the patients. The s.c epinephrine reduces the
admission rate (13%), compared to nebulized salbutamol (24%). The observation that peak
action of s.c epinephrine occurs 30-60 minutes after administration suggests the need for
caution in repetitive administration during this period