In a message dated 12/13/2002 1:16:52 AM Eastern Standard Time, HughesFisherdoc writes:

Subj: Re: racemic epi in bronchiolitis
Date: 12/13/2002 1:16:52 AM Eastern Standard Time
From: HughesFisherdoc
To: [log in to unmask]

Kevin Hughes, MD
After Hours Pediatrics
Tampa, FL                                                                                                                                                                                                                                                     In our urgent care setting, we do not routinely use racemic epi for bronchiolitis, though I have witnessed its efficacy in many cases of hospitalized patients with increased secretions, low O2 sats, and refraction to standard albuterol nebs.  In such cases the benefit is likely from the fairly brief "topical" effects of the epinephrine on the leaky airway epithelium.  Its side effect profile and patient rebound potential as it wears off makes it an unpleasant choice for the management of the non-hospitalized patient.