Epinephrine is efficacious for outpatient treatment of bronchiolitis

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Q&A

Epinephrine is efficacious for outpatient treatment of bronchiolitis

J Fam Pract. 2004 March;53(3):172-188

By

Joseph J. Saseen, PharmD

BACKGROUND: Inhaled epinephrine is the most frequently prescribed bronchodilator for acute viral bronchiolitis. It stimulates alpha-receptors in the bronchiolar vasculature and may potentially be more effective than other commonly used bronchodilators (ie, albuterol and ipratropium). Although some data suggest that epinephrine is more effective than placebo in ambulatory patients, its benefit has not been universally accepted due to inconsistent findings in clinical trials and a lack of demonstrated response in hospitalized patients.
POPULATION STUDIED: In this meta-analysis, the researchers included randomized, double-blind, clinical trials evaluating the efficacy of epinephrine vs placebo or epinephrine vs other bronchodilators in the treatment of bronchiolitis for hospitalized or ambulatory patients aged 2 years or younger. Bronchiolitis was defined as wheezing (with or without cough, tachypnea, and increased respiratory effort) associated with clinical evidence of a viral infection (eg, coryza and fever).
STUDY DESIGN AND VALIDITY: One researcher searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and reference lists from articles to identify eligible clinical trials. Non-English-language publications were translated for evaluation. The researcher included a study if it reported at least 1 of the following outcome measures: clinical score, oxygen saturation (via oximetry), admission rates, length of hospital stay, respiratory rate, heart rate, and results of pulmonary function tests.
OUTCOMES MEASURED: Inpatient and outpatient study data were compared independently. Clinical scores of response at different times after treatment, changes in oxygen saturation, “improvement,” length of stay, and pallor after treatment were reported. The researchers converted the data into standardized mean differences in clinical scores (effect size).
RESULTS: Fourteen clinical trials (7 inpatient, 6 outpatient, and 1 unknown) were included in this meta-analysis. All the studies were small, with the largest including only 194 patients.

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Epinephrine is efficacious for outpatient treatment of bronchiolitis

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