Racemic epinephrine compared to salbutamol in hospitalized young children with bronchiolitis; a randomized controlled clinical trial [ISRCTN46561076]

被引：29
作者：
Langley J.M. [1 ,2 ,3 ]
Smith M.B. [4 ]
LeBlanc J.C. [2 ,3 ,5 ]
Joudrey H. [1 ]
Ojah C.R. [2 ,6 ]
Pianosi P. [7 ]
机构：
[1] Clinical Trials Research Centre, Dalhousie University, Halifax, NS
[2] Department of Pediatrics, Dalhousie University, Halifax, NS
[3] Department of Community Health, Dalhousie University, Halifax, NS
[4] Department of Pediatrics, Queen's University, Belfast and Craigavon Area Hospital, Craigavon
[5] Department of Psychiatry, Dalhousie University, Halifax, NS
[6] Saint John Regional Hospital, Atlantic Health Sciences Corporation, Saint John, Nfld.
[7] Division of Allergy, Immunology and Pulmonology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
来源：
BMC Pediatrics | / 5卷 / 1期
关键词：
Respiratory Syncytial Virus; Salbutamol; Bronchiolitis; Montelukast; Respiratory Syncytial Virus Infection;
D O I：
10.1186/1471-2431-5-7
中图分类号：
学科分类号：
摘要：
Background: Bronchiolitis is the most common cause of lower respiratory tract illness in infancy, and hospital admission rates appear to be increasing in Canada and the United States. Inhaled beta agonists offer only modest short-term improvement. Trials of racemic epinephrine have shown conflicting results. We sought to determine if administration of racemic epinephrine during hospital stay for bronchiolitis improved respiratory distress, was safe, and shortened length of stay. Methods: The study was a randomized, double-blind controlled trial of aerosolized racemic epinephrine compared to salbutamol every one to 4 hours in previously well children aged 6 weeks to ≤ 2 years of age hospitalized with bronchiolitis. The primary outcome was symptom improvement as measured by the Respiratory Distress Assessment Instrument (RDAI); secondary outcomes were length of stay in hospital, adverse events, and report of symptoms by structured parental telephone interview one week after discharge. Results: 62 children with a mean age of 6.4 months were enrolled; 80% of children had Respiratory Syncytial Virus (RSV). Racemic epinephrine resulted in significant improvement in wheezing and the total RDAI score on day 2 and over the entire stay (p < 0.05). The mean LOS in the epinephrine arm was 2.6 days (95% CI 2, 3.2) v. 3.4 days in those in the salbutamol group (95% CI 2.6, 4.2) (p > 0.05). Adverse events were not significantly different in the two arms. At one week postdischarge, over half of parents reported that their child still had a respiratory symptom and 40% had less than normal feeding. Conclusion: Racemic epinephrine relieves respiratory distress in hospitalized infants with bronchiolitis and is safe but does not abbreviate hospital stay. Morbidity associated with bronchiolitis as identified by parents persists for at least one week after hospital discharge in most infants. © 2005 Langley et al; licensee BioMed Central Ltd.
引用
收藏
页数：7
相关论文
共 28 条
[1]  
Wright A.L., Taussig L.M., Ray C.G., Harrison H.R., Holberg C.J., The Tucson Children's Respiratory Study II. Lower respiratory tract illness in the first year of life, Am. J. Epidemiol., 129, pp. 1232-1246, (1989)
[2]  
McConnochie K.M., Roghmann K.J., Liptak G.S., Hospitalization for lower respiratory tract illness in infants: Variation in rates among counties in New York State and areas within Monroe County, J. Pediatr., 12, pp. 6220-6229, (1995)
[3]  
Shay D.K., Holman R.C., Newman R.D., Liu L.L., Stout J.W., Anderson L.J., Bronchiolitis-associated hospitalizations among US children, 1980-1996, Jama, 282, pp. 1440-1446, (1999)
[4]  
Langley J.M., LeBlanc J.C., Smith B., Wang E.E., Increasing incidence of hospitalization for bronchiolitis among Canadian children, 1980-2000, J. Infect. Dis., 188, pp. 1764-1767, (2003)
[5]  
Wickman M., Farahmand B.Y., Persson P.G., Pershagen G., Hospitalization for lower respiratory disease during 20 yrs among under 5 yr old children in Stockholm County: A population based survey, Eur. Respir. J., 11, pp. 366-370, (1998)
[6]  
Kellner J.D., Ohlsson A., Gadomski A.M., Wang E.E., Bronchodilators for bronchiolitis, Cochrane Database Syst. Rev., (2000)
[7]  
Barr F.E., Patel N.R., Newth C.J.L., The pharmacologic mechanism by which inhaled epinephrine reduces airway obstruction in respiratory syncytial virus-associated bronchiolitis, J. Pediatr., 16, pp. 699-700, (2000)
[8]  
Wohl M.E., Chernick V., State of the art: Bronchiolitis, Am. Rev. Respir. Dis., 118, pp. 759-781, (1978)
[9]  
Hartling L., Wiebe N., Russell K., Patel H., Klassen T.P., A meta-analysis of randomized controlled trials evaluating the efficacy of epinephrine for the treatment of acute viral bronchiolitis, Arch. Pediatr. Adolesc. Med., 157, pp. 957-964, (2003)
[10]  
Hartling L., Wiebe N., Russell K., Patel H., Klassen T., Epinephrine for bronchiolitis, Cochrane Database Syst. Rev., 1, (2004)
123