Racemic Adrenaline and Inhalation Strategies in Acute Bronchiolitis

• Published in: The New England journal of medicine Vol. 368; no. 24; pp. 2286 - 2293
• Main Authors: Skjerven, Håvard Ove, Hunderi, Jon Olav Gjengstø, Brügmann-Pieper, Sabine Kristin, Brun, Anne Charlotte, Engen, Hanne, Eskedal, Leif, Haavaldsen, Marius, Kvenshagen, Bente, Lunde, Jon, Rolfsjord, Leif Bjarte, Siva, Christian, Vikin, Truls, Mowinckel, Petter, Carlsen, Kai-Håkon, Lødrup Carlsen, Karin C
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 13-06-2013
• Subjects: Acute Disease; Administration, Inhalation; Age Factors; Biological and medical sciences; Bronchiolitis - drug therapy; Bronchiolitis - therapy; Bronchopneumonia; Children; Chronic obstructive pulmonary disease, asthma; Clinical trials; Combined Modality Therapy; Disease; Double-Blind Method; Double-blind studies; Drug Administration Schedule; Drug therapy; Epinephrine; Epinephrine - administration & dosage; Feeding; Female; General aspects; Hospitalization; Hospitals; Humans; Hypersensitivity - complications; Infant; Infants; Inhalation; Isomerism; Kaplan-Meier Estimate; Length of Stay; Male; Medical sciences; Motivation; Oxygen; Oxygen Inhalation Therapy; Pediatrics; Pneumology; Racepinephrine; Respiration, Artificial; Sex Factors; Sodium Chloride - administration & dosage; Supplements; Norway; Epinephrine; Medicine; Racemic; Respiratory disease; Acute; Neurotransmitter; Bronchus disease; Strategy; Catecholamine; Bronchiolitis; Inhalation
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1301839

In this study of infants with bronchiolitis, there was no difference in the length of hospital stay between those treated with inhaled adrenaline and those treated with inhaled saline. Infants treated on demand had a shorter length of stay than those treated on a fixed schedule.
Acute bronchiolitis in infants, which frequently leads to hospitalization
1
,
2
and sometimes requires ventilatory support, is occasionally fatal
3
; it is usually viral in origin, with respiratory syncytial virus
4
being the most common cause. The clinical disease is characterized by nasal flaring, tachypnea, dyspnea, chest retractions, crepitations, and wheezing.
5
Bronchodilators are not recommended
6
,
7
but are often used in the treatment of bronchiolitis,
8
–
10
as are saline inhalations. Adrenaline reduces mucosal swelling,
11
giving it an edge over the β
2
-adrenergic agonists,
12
and has led to the frequent use of inhaled adrenaline,
13
which has improved symptoms
12
,
14
–
20
and reduced . . .