Letters to the Editor

Indian Pediatrics 2002; 39:1171

Reply

We are thankful to Okutan et al for showing interest in our article regarding the efficacy of nebulised L-adrenaline in WLRI in infants(1). They have shared their experience using nebulised L-adrenaline in children with bronchiolitis in Turkey. Although the study was published in Turkish in a non indexed journal in the year 1988, the same was not available to us during our search of literature. Okutan et al have found in their study that both nebulised salbutamol and L-adrenaline are more effective than placebo treatment but they have not found L-adrenaline to be any better from salbutamol in this condition. However, there are some differences in the study methodologies which may account for the differences in the outcomes in the two studies. The Turkish group had a relatively small sample size (only 15 patients in each arm of the study) and they evaluated the effect of a single nebulized dose unlike three doses in first hour used by us. We must remind that inour study most of the improvement in the oxygen saturation and other parameters occurred after the second dose of the nebulized drug.

An important piece of data which is now emerging is that nebulized L-adrenaline is as effective as its expensive cousin the racemic form which is also not available in most of the less industrialized world. They ahve also quoted some more recent studies which have found nebulisations with L-adrenaline to be better than salbutamol in the management of bronchiolitis(2).

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. 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.