The 3 studies of bronchiolitis reported in the February issue of Archives of Pediatrics and Adolescent Medicine1-3 demonstrate the disconnect between the evidence and the practice of pediatrics in America.
The study of Mull et al1 comparing epinephrine and albuterol sulfate found no important difference in efficacy. They assert that both medications "work." The treatment groups were blinded. But since there was no placebo group, a placebo effect of medications (on the physicians) cannot be ruled out. The Respiratory Distress Assessment Instrument is the most subjective and showed the most medication effect. The respiratory rate is perhaps less subjective, and it did go down some. The mean room air oxygen saturation should be the least subjective assessment and that got worse with treatment according to Figure 4. However, they reported a "significant improvement" in this. Does that represent an error?
DiTraglia J. Bronchiolitis. Arch Pediatr Adolesc Med. 2004;158(7):707. doi:10.1001/archpedi.158.7.707-a
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