There is a great case report by Rick Barr and Neal Patel at Vandy in this
months (I believe) JPeds about epi in bronchiolitis. A child on propranolol
for orthdromic reciprocating SVT treated with epi nebs. They sensibly
suggest the case shows strong evidence that alpha agonist activity of epi is
the critical reason for the usefulness of epi in bronchiolitis. Knowing
these two guys, I think they are on to something.
IRT steroids in bronchiolitis: a meta analysis is a poor substitute for a
good study :-) While intuitively it makes sense that steroids should work
on an inflammatory component of bronchilolitis, I've always felt it does
little for the actual necrosis of tissue that has occurred as a result of
direct viral damage, bronchilolitis's primary malfunction. It makes sense to
me then, that steroids most likely won't have an appreciable effect on
bronchiolitis, but would in asthma, a dedicated inflammatory disease. This
being said, I wonder how the alpha agonist activity of epi helped in
bronchilolitis: I don't have Rick's article here in front of me, but I think
they suggested it was an anti-inflammatory pathway.
More upon which to muse, I suppose...
Ken Schroeter, DO, FAAP
Professional Website: http://sites.netscape.net/kenschroeter/
"Trying is the first step towards failure." - Homer Simpson
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