We enrolled 30 infants (median age 3 months, range 1-12 months), hospitalized for
bronchiolitis in a randomized double-blind trial, to examine the efficacy and safety of nebulized
epinephrine compared to
salbutamol. Once admitted, patients were treated with either nebulized 0.5 mg of an 0.1%
epinephrine solution (0.5 mL in 3.5 mL
normal saline (NS)) or 2.5 mg nebulized
salbutamol (0.5 mL in 3.5 mL NS). They were evaluated daily before and after nebulization until discharge. The outcome measures used were: baseline clinical score (based on respiratory rate, subcostal retraction, presence of
wheezing, and O2 requirement), change in clinical O2 score after nebulization, duration of O2
therapy, and duration of hospitalization. A significant improvement in the clinical score was noted on the first day of hospitalization in subjects receiving
epinephrine (P = 0.025); that change was not seen in those on
salbutamol (P = 0.6). Nebulized
epinephrine decreased the baseline clinical score faster than
salbutamol (P = 0.02), though on the fourth study day there was no significant difference between the two scores. On the fourth and fifth days of study there were more patients hospitalized in the
salbutamol group than in the
epinephrine group (P = 0.03 vs. P = 0.025). No adverse effects were associated with nebulized
therapy. We conclude that nebulized
epinephrine is a more effective agent than
salbutamol in the initial treatment of
bronchiolitis and is equally safe.