Affiliations: Pediatric Ambulatory Center, General Health Services,
Petach Tikva, Israel | The Jesse Z. and Sara Lea Shafer Institute for
Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider
Children's Medical Center of Israel, Petach Tikva, and Sackler Faculty of
Medicine, Tel Aviv University, Tel Aviv, Israel
Note: [] Correspondence: Dr. E. Michael Sarrell, M.D, 7 Ha'Iris St.,
Moshav Gan Hayim, 44910, Israel. Tel.: +972 9 7409610; +972 544289279; Fax:
+972 9 7403196; E-mail: michaelsar@clalit.org.il
Abstract: The aim of the study was to investigate the utility of combining
inhaled epinephrine with bromhexine, a mucolytic agent, for the management of
viral bronchiolitis in an outpatient setting. A randomized double blind,
placebo-controlled parallel-group design was used. Three hundred thirty
patients aged 1–14 months with respiratory syncytial virus bronchiolitis
attending two primary pediatric community clinics were randomly assigned to
receive treatment (wet nebulized aerosol) with single-isomer epinephrine
diluted (1:1000) in either 2 mL or 2.5 mL (by age) 0.9% saline (control
group) or 2 mL or 2.5 mL bromhexine (study group), or 2 mL or 2.5 mL 0.9%
saline only (placebo group) (n=110 each). Treatment was administered three
times daily for 7 days. Primary outcome measures were changes in bronchiolitis
caregiver diary score and pulse oximetry results; secondary outcome measures
were emergency department visits/hospitalization and illness-related loss of
daycare (patient) or work (parent) days. Baseline background and clinical
characteristics were similar in all groups. The study group had significantly
lower bronchiolitis caregiver diary scores than the control and placebo groups
at all time points (P< 0.0001), significantly greater
improvement in pulse oximetry results on days 2 and 4 (P=0.034 and 0.003 respectively), and fewer days missed from daycare/ work. There
were no significant differences in hospital admissions, but the risk reduction
was lowest in the study group. In children with bronchiolitis, treatment with
nebulized epinephrine and bromhexine appears to lead to more rapid clinical
improvement than epinephrine alone, thereby reducing the burden of care.
