Table 1

Nebulised adrenaline in bronchiolitis

CitationStudy groupStudy type (level of evidence)OutcomesKey resultsComments 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 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 (2 doses) versus nebulised salbutamol
Grade A
Double blind RCT
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%)
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 placeboIncluded some recurrent wheezers
Kristjansson et al (1993)29 infants (<18 mth) with acute bronchiolitis.
Adrenaline versus placebo
Grade A
Double blind RCT
Symptom scoreSignificant improvement with adrenalineBoth groups included recurrent wheezers
Oxygen saturationSignificant improvement with adrenaline
Bertrand et al (2001)30 infants (<12 mth) with acute bronchiolitis.
Adrenaline versus salbutamol
Grade A
Double blind RCT
Clinical scoreSignificant improvement with adrenaline cf salbutamol at day 1, although by day 4, no difference
Length of stayAt 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 admission6/45 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, RRSignificant 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 scoreSignificant 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 mechanicsSignificant 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 scoreNo significant differenceOnly 1 dose adrenaline given. All patients admitted regardless of clinical state to assess safety. No adverse events with adrenaline
Sao2No significant difference
Lodrup et al (2000)16 infants with acute bronchiolitis, given adrenaline. Compared with 7 healthy controlsGrade C
Controlled trial
Before and after lung functionLung function in bronchiolitis reduced and improved significantly after adrenaline. Also improved clinical score