Nebulized epinephrine for young children with bronchiolitis.

QUESTION: Every winter I see infants with flulike symptoms and wheezing. I frequently diagnose them with bronchiolitis based on their presenting symptoms. Would it be prudent to send those infants to the nearest emergency department for treatment with nebulized epinephrine?

ANSWER: Nebulized epinephrine should not be routinely used in infants with bronchiolitis. It is an option to consider in those with severe symptoms. If it is given and there are no signs of improvement, further doses are discouraged. Ongoing studies of epinephrine combined with other agents (eg, hypertonic saline, oral dexamethasone) are needed to confirm their benefit.