Nebulised adrenaline in bronchiolitis
| Citation | Study group | Study type (level of evidence) | Outcomes | Key results | Comments and study weaknesses |
|---|---|---|---|---|---|
| Kellner et al (1996) | Wheeze <24 mth. Looking at a range of bronchodilators (incl adrenaline) compared to placebo | Grade A Systematic review—most studies double blind RCTs | Clinical score | Slight improvement in bronchodilator group, RR=0.76 (95% CI 0.6 to 0.95) | May have seen a slight improvement because of inclusion of recurrent wheezers |
| Hospital admission | No difference, RR=0.85 (95% CI 0.47 to 1.53) | ||||
| Menon et al (1995) | 42 first time wheezers less than 12 months. Nebulised adrenaline (2 doses) versus nebulised salbutamol | Grade A Double blind RCT | Hospital admission | Significant difference. 33% cf 81% admitted. NNT=2 (95% CI 1 to 5) | Small study |
| Oxygen saturation | Significantly higher in adrenaline group at 1 h (96% v 94%) | ||||
| Reijonen et al (1995) | 100 consecutive wheezers less than 24 months admitted. Compared adrenaline, salbutamol, and placebo (normal saline) | Grade A Double blind RCT | Mean symptom score change using the Respiratory Distress Assessment Instrument (RDAI) | Significant between adrenaline and placebo (but not significant between salbutamol and placebo | Included some recurrent wheezers |
| Kristjansson et al (1993) | 29 infants (<18 mth) with acute bronchiolitis. Adrenaline versus placebo | Grade A Double blind RCT | Symptom score | Significant improvement with adrenaline | Both groups included recurrent wheezers |
| Oxygen saturation | Significant improvement with adrenaline | ||||
| Bertrand et al (2001) | 30 infants (<12 mth) with acute bronchiolitis. Adrenaline versus salbutamol | Grade A Double blind RCT | Clinical score | Significant improvement with adrenaline cf salbutamol at day 1, although by day 4, no difference | |
| Length of stay | At day 4, significantly less adrenaline still admitted | ||||
| Ray and Singh (2002) | 91 infants (<24 mth with 1st or 2nd episode of wheeze). l-adrenaline 3 doses versus salbutamol | Grade A Double blind RCT | Hospital admission | 6/45 v 14/46 = ARR of 17% (0.5%, 33.7%), NNT=6 (3, 200) | Some infants with 2nd episode of wheeze included. 90% subjects were less than 12 mth of age (mean age 5–6 mth) |
| Clinical score, Sao2, RR | Significant improvement in adrenaline group cf salbutamol. Sao2 only showed improvement after 2nd and subsequent doses, not 1st | ||||
| Sanchez et al (1993) | 24 infants <1 y, with first episode of bronchiolitis. Adrenaline versus salbutamol | Grade A Double blind RCT (crossover study) | Clinical score | Significant improvement with adrenaline cf salbutamol, NNT=4 (95%CI 3 to 7) | Mean age 4.6 mth (±0.5). Patients sedated with chloral hydrate |
| Pulmonary mechanics | Significant improvement with adrenaline cf salbutamol | ||||
| Abul-Ainie and Luyt (2002) | 38 infants (<12 mth) with bronchiolitis. l-adrenaline (1 dose) versus placebo (normal saline) | Grade A Double blind RCT | Clinical score | No significant difference | Only 1 dose adrenaline given. All patients admitted regardless of clinical state to assess safety. No adverse events with adrenaline |
| Sao2 | No significant difference | ||||
| Lodrup et al (2000) | 16 infants with acute bronchiolitis, given adrenaline. Compared with 7 healthy controls | Grade C Controlled trial | Before and after lung function | Lung function in bronchiolitis reduced and improved significantly after adrenaline. Also improved clinical score |