Racemic Adrenaline and Inhalation Strategies in Acute Bronchiolitis

Skjerven HO, Hunderi JO, Brügmann-Pieper SK, et al

N Engl J Med. 2013;368:2286-2293

Study Summary

Although inhaled epinephrine (adrenaline) has been found to reduce the need for hospitalization when given to patients with bronchiolitis in the emergency department, it is not clear whether continuing nebulized epinephrine in the hospital will alter the hospital course of bronchiolitis in children. This multicenter, double-blind trial, conducted in Norway, used a 2 x 2 factorial design in which both the inhaled substance (epinephrine vs saline) and the frequency of delivery (on demand vs scheduled) were randomized. This resulted in 4 study groups of children who received the 2 different interventions in different combinations.

A total of 404 children (59% boys) were enrolled in 2010 and 2011. All children were younger than 12 months (mean age, 4.2 months) and met a clinical definition of bronchiolitis; all had significant symptoms, meaning that patients with mild symptoms were generally excluded. Most (81%) of the infants had bronchiolitis due to respiratory syncytial virus. The trial excluded patients with chronic medical conditions that would otherwise potentially alter treatment, as well as any who had received steroids within 4 weeks of presenting. In Norway, hospitalized children with bronchiolitis do not receive glucocorticoids or beta-adrenergic agonists.

The primary outcome of interest was hospital length of stay. The investigators evaluated several secondary outcomes, including whether nasogastric tube feedings were used and whether patients required oxygen or ventilatory support.