There's no advantage to using a less beta-2 specific agent by nebulization
in the treatment of adult asthma.
In children I can think of 2 situations where you might want to: 1) kids
presenting simultaneously with croup and brochiolitis (1-3%--I've seen a
couple of these). The alpha effects of epi for the upper and the beta
effects for the lower airway obstruction and 2) epi appears to be just as
good and arguably better then albuterol for reactive airway disease due to
Strictly for asthma, however, the only role of epi that I can see is in
its SC use for those uncommon situations (pre-intubation) where
continuous nebulizations are ineffective.
(1) Reijonen T, Korppi M, Pitkakangas S, Tenhola S, Remes K
The clinical efficacy of nebulized racemic epinephrine and albuterol in
acute bronchiolitis. Arch Pediatr Adolesc Med 1995 Jun;149(6):686-92
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