There would seem to be a fundamental difference between croup and
bronchiolitis. In croup, it is quite clear that corticosteroids are
effective in reducing illness severity after discharge(1). Quite the
opposite in bronchiolitis, in which neither oral or IM dexamethasone appear
to modify the acute course of illness (2,3).
While epinephrine is effective in the short term in both
disorders, unless one is willing to discharge patients on continued
nebulized epinephrine therapy, it seems likely that the improvement in
bronchiolitis will not be sustained after discharge.
The controlled trial at CHEO reported an 81% admission rate in
infants treated with albuterol and a 33% rate in those treated with 3 ml of
1:1000 L-epinephrine (NNT=2). However, overall study size was small (n=42)
and the only longer term outcome measure was return for return for further
treatment within 24 hours (4).
Given the low morbidity of mild to moderate bronchiolitis in older
infants, those who have transient improvement after epinephrine probably
muddle through at home.
2. Klassen T, Sutcliffe T, Watters L Dexamethasone in salbutamol-treated
patients with acute bronchiolitis: a randomised controlled trial. J
3. Rossevelt G, Grupp-Phelan J, Tanz R et al. Dexamethasone in
bronchiolitis: a randomized controlled trial. Lancet 1996; 348: 292-295.
4. Menon K, Sutcliffe T, Klassen TP. A randomized trial comparing the
efficacy of epinephrine with salbutamol in the treatment of acute
bronchiolitis. J PEDIATR 1995;126:1004-7.
At 01:45 PM 5/18/00 -0400, Conners, Gregory wrote:
>It seems to me that the issue with epi nebs for croup is that upper airway
>obstruction can recur when the epi wears off, so we wait to make sure that
>won't happen. Epi nebs for bronchiolitis are a different issue. Just like we
>don't admit everyone who gets an Albuterol neb, I don't admit bronchiolitics
>who get epi nebs. Others?
>Greg Conners, MD, MPH
>Univ. of Rochester
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