Letters to the Editor

Indian Pediatrics 2002; 39:1170-1171

Nebulized Adrenaline vs. Salbutamol in Wheeze associated Respiratory Infections

We read with great interest the article by Ray and Singh(1), in which they reported the superiority of L-adrenaline to salbutamol after comparing their efficacies in the treatment of wheeze associated with respiratory tract infection. We would like to report our findings about the use of nebulized L-adrenaline and salbutamol in the treatment of infants with bronchiolitis.

We compared the efficacies of nebulized bronchodilators (L-adrenaline and salbutamol) in 45 infants (28 male and 17 female, aged 3-18 months) in a double-blind, placebo controlled study(2). The patients received nebulized L-adrenaline at a dose of 0.2 mg/kg (Group A), salbutamol at a dose of 0.15 mg/kg (Group B) or physiologic saline as placebo (Group C) after sedation with chloral hydrate. The bronchodilators and placebo were administered as single doses by a nebulizer with a flow rate of 7 L/min. In all groups respiratory distress index (RDI)(3), rate of respiration, oxygen saturation and heart rate were assessed initially and at 15th, 30th, 45th, 60th, 120th minutes of therapy thereafter. RDIand rate of respiration showed significant improvements at 30th, 60th and 120th minutes in Group A (P < 0.05), and at 30th, 45th, 60th and 120th minutes in Group B (P < 0.05) when compared to Group C. None of the drugs exerted any significant effects on either oxygen saturation or heart rate, and no patients experienced any adverse events or deterioration in blood pressure. There were no significant difference between the efficacies of the two bronchodilators ( p > 0.05).

Menon et al.(4) compared the efficacy of nebulized L-adrenaline with that of salbutamol in the treatment of acute bronchiolitis, and they found that L-adrenaline was a more effective and equally safe medication. In a randomized double-blind trial, Bertrand et al.(5) examined the efficacy and safely of nebulized L-adrenaline and salbutamol in 30 infants with bronchiolitis. They found a significant clinical improvement in patients receiving L-adrenaline on the first day of hospitalization without adverse effects whereas no improvement was observed with salbutamol, and L-adrenaline was reportedly superior to salbutamol in the initial treatment of bronchiolitis.

Oxygen desaturation following L-adrenaline administration was reported in infants with bronchiolitis who were treated with nebulized L-adrenaline(6). In addition to Ray and Singh(1) and Bertrand et al(5) we also did not encounter such adverse effect. The reason for this undesirable effect might be the use of relatively higher doses of L-adrenaline (0.5 mg/kg up to maximal 5 mg of 1/1000 L-adrenaline solution) in that study as well as the metabisulfite content and acidity of the solution.

Demonstrating the equal efficacy of L-adrenaline to salbutamol in our placebo controlled study we think that nebulized adrenaline is an effective and safe mode of therapy in the initial treatment of infants with bronchiolitis, especially in countries where the racemic form of L-adrenaline is not available.

References

1. Ray MS, Singh V. Comparison of nebulised adrenaline versus salbutamol in wheeze associated respiratory infections in infants. Indian Pediatr 2002; 39: 12-22.

2. Okutan V, Akin R, Kurekci AE, Yanik A, Ozcan O, Gokcay E. Effectiveness of nebulised adrenaline and salbutamol in the treatment of infants with bronchiolitis. Gulhane Med 1998; 40: 199-204.

3. Becker AB, Nelson NA, Simons FER. The pulmonary index assesment of a clinical score for asthma. Am J Dis Child 1984; 138: 574-576.

4. Menon K, Sutcliffe T, Klassen TP. A randomized trial comparing the efficacy of adrenaline with salbutamol in the treatment of acute bronchiolitis. J Pediatr 1995; 126: 1004-1007.

5. Bertrand P, Aranibar H, Castro E, Sanchez I. Efficacy of nebulised epinephrine versus salbutamol in hospitalized infants with bronchiolitis. Pediatr Pulmonol 2001; 31: 284-288.

6. Ruscani F, Sideri S. Efficacy of epinephrine with salbutamol in treatment of acute bronchiolitis. J Pediatr 1996; 128: 441-443.