We thank Dr DiTraglia for his interest in our study. We appreciate the opportunity to address his thoughtful commentary.
Our decision to compare epinephrine with albuterol was based on our clinical observation that a substantial proportion of infants moderately ill with bronchiolitis responds favorably to bronchodilators. This proportion was appreciated to be high enough that we felt it unjustified to deny therapy to a placebo group. In light of the Menon et al1 study, our goal was to clarify the role of epinephrine in comparison with albuterol in the treatment of such infants. At the time that this study was conducted, the standard of care for these patients at our institution included provision of a trial of nebulized albuterol. As such, the hospital's institutional review board would not have approved a placebo study.
Mull CC, Scarfone RJ. Bronchiolitis—Reply. Arch Pediatr Adolesc Med. 2004;158(7):707. doi:10.1001/archpedi.158.7.707-b