Table 3-3
Citation Study group Study type
(level of evidence)
Outcome Key results Comments
Kellneret al (1996)Wheeze <24 months. Looking at a range of bronchodilators (incl adrenaline) compared to placeboSystematic review—most studies double blind RCTs (level 1a)Clinical scoreSlight 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 admissionNo 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 cf nebulised salbutamolDouble blind RCT (level 1b)Hospital admissionSignificant difference 33% cf 81% admitted; NNT = 2 (95% CI 1 to 5)Small study
Oxygen saturationSignificantly higher in adrenaline group at 1 h (96%v 94%)
Reijonenet al (1995)100 consecutive wheezers less than 24 months admitted. Compared adrenaline, salbutamol and placebo (N saline) Double blind RCT (level 1b)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 months) with acute bronchiolitis. Adrenaline cf placeboDouble blind RCT (level 1b)Symptom scoreSignificant improvement with adrenalineBoth groups included recurrent wheezers
Oxygen saturationSignificant improvement with adrenaline
Sanchez et al (1993)24 infants <1 y, with first episode of bronchiolitis. Adrenaline cf salbutamol Double blind crossover RCT (level 1b)Clinical scoreSignificant improvement with adrenaline cf salbutamol; NNT = 4 (95% CI 3 to 7)Mean age 4.6 months (±0.5). Patients sedated with chloral hydrate
Pulmonary mechanicsSignificant improvement with adrenaline cf salbutamol