A Cochrane review [Abstract] 1 included 19 studies with a total of 2 256 children less than two years with acute viral bronchiolitis. Epinephrine versus placebo among outpatients showed a significant reduction in admissions at day 1 (RR 0.67, 95% CI 0.50 to 0.89; 5 studies, n=995) but not at day 7 (RR 0.81, 95% CI 0.63 to 1.03; 3 studies, n=875). There was no difference in length of stay (LOS) for inpatients. Epinephrine versus salbutamol showed no differences among outpatients for admissions at day 1 or 7. Inpatients receiving epinephrine had a significantly shorter LOS compared to salbutamol (MD -0.28, 95% CI -0.46 to -0.09; 4 studies, n=261). One large outpatient study showed a significantly lower admission rate at day 7 for epinephrine and steroid combined versus placebo (RR 0.65, 95% CI 0.44 to 0.95; 1 study, n=400). There were no important differences in adverse events.
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).
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