A randomized controlled trial of nebulized epinephrine versus nebulized hypertonic saline in infants with acute bronchiolitis

Background: Acute Bronchiolitis is an infection of the lower respiratory tract, most frequently caused by the respiratory syncytial virus. It is one of the most common cause of hospital admission for respiratory tract illnesses in infants. This is a double blinded randomized controlled trial, conducted to compare the therapeutic efficacy of nebulized epinephrine versus nebulized hypertonic saline in infants with acute bronchiolitis.Methods: It was a double blinded randomized controlled trial conducted over a period of 18 months (January 2019-June 2020) in infants aged 2 months to 1 year diagnosed with acute bronchiolitis. All eligible patients were randomly assigned to one of two groups: Group I received inhalation of Epinephrine; Group II received inhalation of Hypertonic (3%) Saline. Patients in each group received four treatments on each day of hospitalization, delivered at 6 hourly intervals. Monitoring parameters for improvement or worsening of the condition were measured and recorded on admission and then at 24 hourly intervals using the clinical score described by Wang, et al for the first three days of treatment.Results: Among the infants treated with hypertonic saline, there was a significant decrease in the post inhalation respiratory score on day 2 and day 3 as compared to the infants treated with epinephrine. There was a significant difference in duration of hospitalization between the two groups as duration of hospitalization in infants was less in hypertonic saline group as compared to the epinephrine group. Hypertonic saline also showed significantly lesser side effects post inhalation when compared to epinephrine. The difference was statistically significant with p<0.0001.Conclusions: The study concluded that the use of nebulized hypertonic saline in infants aged 2 months to 12 months, provides evidence for its role as an efficient treatment modality in the treatment of acute bronchiolitis. The study also found that nebulized epinephrine had more side effects associated with it.