COMPARISON OF EFFICACY OF IPRATROPIUM BROMIDE VERSUS EPINEPHRINE IN ACUTE BRONCHIOLITIS IN INFANTS

ABSTRACT
Background: Bronchiolitis, viral infection of lower respiratory tract of infants is the leading cause of infants morbidity
and hospitalization. Yearly up to 30% of healthy infants are hospitalized for Bronchiolitis resulting in an estimated
12,000 hospitalization. The effects are not limited to the acute illness episode because 40-50% of children diagnosed
with Bronchiolitis suffer from subsequent wheezing and air way reactivity Asthma. Attempts to address the burden of
disease via vaccine development have largely been unsuccessful and treatment is purely supportive rather than curative.
Furthermore the medical therapies for acute Bronchiolitis in young infants are controversial. Anti cholinergic agent
ipratropium bromide has been shown to reduce the work of breathing in infant of Bronchiolitis in controlled clinical trials.
Objectives: Comparison of efficacy of ipratropium bromide verses epinephrine in Acute Bronchiolitis in infants.
Materials and Methodes: The efficacy of ipratropium and epinephrine in acute Bronchiolitis were compared in the
department of Paediatrics, Hayatabad Medical Complex, Peshawar through double blinded randomized controlled
study. The study started on March 12,2014 and ended on 11 August -2014, the peak season for Bronchiolitis. A total
of 334 infants under 12 months were randomly allocated in two groups. Group A infants were subjected to nebulized
ipratropium and infants of group B were given nebulized epinephrine. A standardized respiratory distress assessment
instrument (RDAI) was used to measure the improvement of symptoms. The assessment was done on initial arrival
(base line) and 24 hours after the initiation of therapy.
Result: The mean age of the infants in group A was 7.47 2.7 months while in group B it was 6.9 2.5 months (P value
0.085). The mean follow up RDAI score in group A was 2.0 0.7 while group B it was 2.2 0.6 ( P value 0.000). The overall
efficacy in group A was 70.1% and in group B it was 62.3% (P value 0.133).
Conclusion: Ipratropium bromide is equally effective as epinephrine in the treatment of acute Bronchiolitis in children
below 12 months of age.
Key Words: Acute Bronchiolitis, Ipratropium bromide, epinephrine, respiratory distress assessment instrument.