Epinephrine Doesn't Work on Very Young

Kids under 1 with lung infections get no help from inhaled medication, study finds

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By
HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

WEDNESDAY, July 2, 2003 (HealthDayNews) -- A popular inhalation treatment for bronchiolitis, the most common lower respiratory tract infection in children under the age of 1, does not work.

That's the conclusion of Australian researchers who found that epinephrine, a bronchodilator used to open up the air passages, did not significantly reduce the length of hospital stays or other indicators for infants.

The finding, published in the July 3 issue of the New England Journal of Medicine, is not startling to many clinicians.

"The level of surprise is extremely low," says Dr. Giovanni Piedimonte, director of pediatric pulmonology at the University of Miami School of Medicine. "We have known that bronchodilators have limited efficacy."

"This study really looked at [the issue] critically to say, 'Why are we giving these kids these medications if it doesn't help?'" says Dr. Harriet Boxer, chief of neonatology at Nassau University Medical Center in East Meadow, N.Y.

According to the researchers, about 1 percent of all healthy infants are hospitalized with acute viral bronchiolitis each year. And according to an accompanying editorial in the journal, the estimated number of admissions of children under the age of 1 for this condition increased from 1.3 percent in 1980 to 3.1 percent in 1996. The number of children under the age of 6 months hospitalized during the same time frame surged by 239 percent.

The problem is that there is no effective treatment for the infection. "With bronchiolitis, we have nothing. It's just supportive," Piedimonte says. That means making sure the child doesn't get dehydrated and providing oxygen and ventilatory support if needed.

Despite being controversial, bronchodilators are widely used, report the study authors. Up to 96 percent of infants with bronchiolitis are treated with bronchodilators at pediatric centers in Canada and almost 90 percent of Australian physicians reported that they used bronchodilators in some infants with bronchiolitis.

The current study involved 194 infants who had been admitted to four hospitals in Queensland, Australia, with a diagnosis of bronchiolitis. After parental consent was obtained, the children were randomly assigned to receive either three doses of inhaled epinephrine or three doses of a saline solution as a placebo.

There were no significant differences between the two groups in length of hospital stay or time until the child was ready for discharge (the study authors made this distinction because sometimes the stay can be prolonged for non-health reasons). Nor were there significant differences in respiratory rate or blood pressure.

Some clinicians may resort to bronchodilators because the patient is wheezing and they think it might be asthma.

"We have pretty good evidence that [episodes of bronchiolitis] are very different from actual asthma. However, the main symptom is still wheezing and the child looks the same so it's perfectly understandable that they do it," Piedimonte says.

Other physicians may simply want to do something, anything. "Most of the time they are quite well aware of the literature that shows it doesn't work but, nevertheless, they use it," Piedimonte says. "The fact that the child is extremely sick and very, very young with a family looking on makes many physicians believe that they have to at least try some intervention."

Generally speaking, short courses of bronchodilators are not harmful, although they can speed up the heart rate.

"I don't think [the study] is going to stop people from using it," Boxer says, adding that doctors would be better off using their clinical skills and doing a family history of asthma and whether the child has ever been on a ventilator. "I don't think it will stop because there are people who are convinced that it will help," she says.

More information

For more on bronchiolitis in children, visit the American Academy of Pediatrics or the Nemours Foundation.

SOURCES: Giovanni Piedimonte, M.D., director, pediatric pulmonology, University of Miami School of Medicine; Harriet Boxer, M.D., director, neonatology, Nassau University Medical Center, East Meadow, N.Y.; July 3, 2003, New England Journal of Medicine

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