Dr. Sravya Gopireddy,
BACKGROUND Acute bronchiolitis is the most common lower respiratory tract infection in infants. It is characterized by fever, rhinitis, cough, tachypnoea, expiratory wheeze, crackles and increased respiratory effort. Approximately 20% of children develop bronchiolitis during their first year of life.1 Supportive interventions including humidified oxygen and maintaining hydration remain the mainstay of management. Various other therapies including nebulised 3% saline, 0.9% saline, epinephrine and salbutamol, as well as inhaled and systemic corticosteroids have been studied with varying results. However, there are uncertainties over the optimal treatment strategy of bronchiolitis. METHODS Children were classified as having mild, moderate and severe disease based on clinical severity score by Wang et al.2 Alternate children received nebulisation with 3% NaCl alone (3 ml) and adrenaline with 3% NaCl (0.5 ml + 2.5 ml). Nebulisations were given every 6th hourly for the first 3 days and then tapered based on the symptoms. Clinical Severity Scores were recorded before & after first nebulization at the time of admission and then every morning (i.e., at 24 hrs, 48 hrs. and 72 hrs.). The duration of hospital stay was also studied. RESULTS A total of 277 children were included in the study (between Jan 2107 to June 2018), of which 64.8% of the patients were males and 35.1% were females. The mean age of the presentation was 9.9±6.2 months. The baseline CS (clinical severity) scores at admission in 0-3, 4-8 and 9+ score groups of 3% NS group were 3, 5.78±1.3 and 9.07±0.27 and of adrenaline with 3% NS group were 3, 5.57±1.3 and 9.36±0.49 respectively. After treatment the overall CS scores after 1st nebulisation with 3% NS and adrenaline with 3% NS at admission dropped to 5.21±1.65 and 4.16±1.89 respectively. The overall CS scores after 24 hrs. of nebulisation with 3% NS and adrenaline with 3% NS dropped to 4.95±1.77 and 4.38±2.14 respectively. The overall CS scores after 48 hrs. of nebulisation with 3% NS and adrenaline with 3% NS dropped to 3.67±1.86 and 2.60±2.08 respectively. The mean duration of hospital stay was 3.56±1.10 and 2.80±1.15 days in 3% NS and adrenaline with 3% NS respectively. CONCLUSIONS Adrenaline with 3% NS nebulisation is an effective and safe treatment for acute bronchiolitis. It significantly reduces the clinical severity scores and length of hospital stay as compared to 3% saline alone in acute bronchiolitis.
