In the Journals

Inhaled epinephrine does not reduce hospital stay in at-risk children with bronchiolitis

Inhaled epinephrine appeared to have no effect on reducing hospital stay in children with acute bronchiolitis who developed recurrent bronchial obstruction episodes, atopic eczema or allergic sensitization by 2 years of follow-up, according to study results.

However children who did not develop these diseases did appear to have a significant reduction in hospital stay, according to the researchers.

“The findings in our study contrast with the hypothesis that inhaled epinephrine might be beneficial in children developing asthma, atopic disease or allergy, which has wide support among clinicians,” Håvard Ove Skjerven, MD, an assistant professor in the institute for pediatric research at University of Oslo, and colleagues wrote.

Skjerven and colleagues conducted a 2-year follow up of a randomized, double blind multicenter trial to determine if inhaled epinephrine during acute bronchiolitis in infancy would benefit patients with later recurrent bronchial obstruction, atopic eczema or allergic sensitization.

The initial trial included 404 infants with moderate to severe bronchiolitis from eight hospitals in Norway. The infants either received inhaled epinephrine or saline up to every second hour throughout the hospital stay. This analysis included 294 children reinvestigated at 2 years of age with a parental interview, a clinical examination and a skin prick test for 17 allergens.

Length of stay appeared to be similar at 2 years of follow-up in both subgroups assigned to inhaled epinephrine (n = 153) and saline (n = 141) (P = .4).

In stratified analyses of patients without recurrent bronchial obstruction during the follow-up, length of stay reduced in patients who received inhaled epinephrine (–15.8 hours).

However, length of stay only decreased by 5.3 hours in patients with recurrent bronchial obstruction.

Inhaled epinephrine significantly reduced length of hospital stay (–19.9 hours) in patients without atopic eczema or allergic sensitization (73.8%) at the end of follow-up (P = .003). But, the same did not occur in patients with both sensitizations (P = .24).

“Our study does not support a trial of inhaled epinephrine in children with increased risk of allergic diseases,” the researchers wrote.

In an accompanying editorial, Joseph J. Zorc, MD, MSCE, a professor of pediatrics at Children's Hospital of Philadelphia, agreed with the researchers.

“For now, clinicians can continue to focus on supportive care rather than prescription of epinephrine or bronchodilators for infants admitted with bronchiolitis,” Zorc wrote. “They can counsel parents that there is an increased risk of recurrent wheezing for these infants, but there does not seem to be a useful relation between how the infants respond at time of hospital admission and the development of these future characteristics.” – by Ryan McDonald     

Disclosure: Skjerven reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.

Inhaled epinephrine appeared to have no effect on reducing hospital stay in children with acute bronchiolitis who developed recurrent bronchial obstruction episodes, atopic eczema or allergic sensitization by 2 years of follow-up, according to study results.

However children who did not develop these diseases did appear to have a significant reduction in hospital stay, according to the researchers.

“The findings in our study contrast with the hypothesis that inhaled epinephrine might be beneficial in children developing asthma, atopic disease or allergy, which has wide support among clinicians,” Håvard Ove Skjerven, MD, an assistant professor in the institute for pediatric research at University of Oslo, and colleagues wrote.

Skjerven and colleagues conducted a 2-year follow up of a randomized, double blind multicenter trial to determine if inhaled epinephrine during acute bronchiolitis in infancy would benefit patients with later recurrent bronchial obstruction, atopic eczema or allergic sensitization.

The initial trial included 404 infants with moderate to severe bronchiolitis from eight hospitals in Norway. The infants either received inhaled epinephrine or saline up to every second hour throughout the hospital stay. This analysis included 294 children reinvestigated at 2 years of age with a parental interview, a clinical examination and a skin prick test for 17 allergens.

Length of stay appeared to be similar at 2 years of follow-up in both subgroups assigned to inhaled epinephrine (n = 153) and saline (n = 141) (P = .4).

In stratified analyses of patients without recurrent bronchial obstruction during the follow-up, length of stay reduced in patients who received inhaled epinephrine (–15.8 hours).

However, length of stay only decreased by 5.3 hours in patients with recurrent bronchial obstruction.

Inhaled epinephrine significantly reduced length of hospital stay (–19.9 hours) in patients without atopic eczema or allergic sensitization (73.8%) at the end of follow-up (P = .003). But, the same did not occur in patients with both sensitizations (P = .24).

“Our study does not support a trial of inhaled epinephrine in children with increased risk of allergic diseases,” the researchers wrote.

In an accompanying editorial, Joseph J. Zorc, MD, MSCE, a professor of pediatrics at Children's Hospital of Philadelphia, agreed with the researchers.

“For now, clinicians can continue to focus on supportive care rather than prescription of epinephrine or bronchodilators for infants admitted with bronchiolitis,” Zorc wrote. “They can counsel parents that there is an increased risk of recurrent wheezing for these infants, but there does not seem to be a useful relation between how the infants respond at time of hospital admission and the development of these future characteristics.” – by Ryan McDonald     

Disclosure: Skjerven reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.