What is the difference between adrenaline and salbutamol

This provided an ability for educational organisations to keep lifesaving medicines on hand, to treat children under their care, in an emergency. Current regulations permit organisations such as schools, sporting clubs, scout groups, churches, camps, and other similar organisations to administer these medicines in an emergency.

This recognises that emergencies may arise in places other than schools. Pharmacists may be asked to supply these items to a school or organisation where a specific patient and a therapeutic need cannot be not readily identified.

In this circumstance supply is permitted, but must be related to the official activities of the school or organisation. Pharmacists must still exercise due professional judgement regarding verification of requests, quantities supplied, and counselling offered. The supply of any S3 medicine is at the discretion of the pharmacist who is legally obliged to determine safety prior to purchase.

Pharmacists are expected to counsel and educate on safe use as usual. Pharmacists may also wish to direct purchasers to clinical or workplace guidelines and resources on correct emergency management of these conditions, such as:. Having an adrenaline auto injector or salbutamol for general use e. They must not be viewed by organisations as a substitute for individuals at high risk of anaphylaxis or asthma from needing to carry or have access to their own personal supplies of prescribed life-saving medicines.

Of these, 45 received L-adrenaline 0. Three doses of each drug were given, nebulized with oxygen at 20 minutes intervals. Respiratory rate, RDAI score, clinical status and pulse oxymetry was recorded before intervention and 10 minutes after each dose. Patients who showed significant relief were discharged after an observation period of three hours while those who did not were admitted. The primary outcome was symptom improvement as measured by the Respiratory Distress Assessment Instrument RDAI ; secondary outcomes were length of stay in hospital, adverse events, and report of symptoms by structured parental telephone interview one week after discharge.

The mean LOS in the epinephrine arm was 2. Adverse events were not significantly different in the two arms. Racemic epinephrine relieves respiratory distress in hospitalized infants with bronchiolitis and is safe but does not abbreviate hospital stay. Morbidity associated with bronchiolitis as identified by parents persists for at least one week after hospital discharge in most infants. Peer Review reports. Bronchiolitis is characterized by tachypnea and wheezing due to obstruction of small airways, and therefore treatment has often included use of beta and alpha agonists delivered by aerosol in addition to supportive care.

A systematic review of randomised clinical trials of the efficacy of beta-agonist aerosols suggests they offer only modest short term improvement [ 6 ]. Alpha agonist stimulation of the sympathetic nervous system would be expected to reduce capillary leakage by constricting precapillary arterioles, reducing hydrostatic pressure and consequently bronchial mucosal edema [ 7 ].

Since Wohl and Chernick first suggested this intervention in [ 8 ], multiple studies and systematic reviews [ 9 — 11 ] have been published. While there is evidence that acute symptoms of bronchiolitis measured in the short term may improve with epinephrine, these reviews have called for more studies assessing longer-term outcomes such as duration of stay, and that are clinically relevant to parents, clinicians and the health care system.

We report a randomised controlled trial of aerosolised epinephrine compared to salbutamol throughout hospital stay in infants with bronchiolitis to assess daily clinical improvement respiratory distress, feeding , length of hospital stay and adverse events, and outcomes by parental report one week after discharge to the community.

This study was a randomized, double blind controlled trial of racemic epinephrine Vaponefrin solution 2. Wheezing had to be present on physical examination and was defined as a high-pitched, musical, continuous respiratory sound. Only patients admitted for management of bronchiolitis were eligible.

The parent or guardian had to be able cooperate with study requirements ability to speak, read and write English, have a telephone at home and not expected to move within the next month.

The IWK is a university-affiliated primary and tertiary-care pediatric hospital with an urban population of , and is a referral center for the Maritime provinces population 2 million of Canada. SJRH serves a rural-urban population of , Children were not eligible for enrollment if they had had a previous diagnosis of asthma, were critically ill, or had chronic pulmonary or cardiac disease. Other exclusion criteria included: allergy to sodium metabisulfite, presence of tachycardia exceeding beats per minute, or use of glucocorticoids, sympathomimetic amines or monoamine oxidase inhibitor therapy.

Informed consent was obtained from the parent or guardian prior to enrolment. The protocol was approved by the Ethics Review Board at both participating institutions. Study enrolment occurred in sequential winter respiratory seasons November to April from to Families were approached regarding study participation in the emergency department or within 24 hours of admission. Research nurses were available to enroll patients between 8 am and 8 pm.

Treatment allocation was determined by randomization, performed in blocks of four by the pharmacy department using a computer-generated random numbers table. Study drug was packaged in identical multidose vials labeled "study drug" with a code number.

Both salbutamol and racemic epinephrine are clear, colorless liquids that are indistinguishable [ 12 ]. Participants were allocated to racemic epinephrine, 0. Study drug was administered every one to four hours or more frequently at the request of the attending physician. Study drug was delivered by a wall flowmeter-nebulizer with face mask Hospitak Inc.

A standard order sheet was used to ensure consistency of trial methodology. Salbutamol was given in 3 ml normal saline at a dosage of 1. The heart rate was measured continuously during each aerosol and for one hour after. The heart rate, vomiting, presence of tremors or pallor were recorded in the health record by the bedside nurse at the end of every aerosol and one hour post aerosol.

Baseline demographic data collected at study entry included inclusion and exclusion criteria, age, gender, concomitant medications and other illnesses. At the time of study enrolment and then daily every morning thereafter the study nurse measured oxygen saturation and wheezing and retractions using the Respiratory Distress Assessment Instrument Table 1 [ 13 ], which was the primary outcome measure of the study. At the daily assessment, the study nurse interviewed caregivers and reviewed the health record to determine if adverse events were present vomiting, tremors, pallor , the feeding pattern and recorded the maximum daily heart rate for that hour period.

During the first two study enrolments, it was noted that a bright red nasal discharge was observed in some study participants, and interpreted by bedside nurses as bloody nasal discharge. This discoloration of nasal mucous was found to be a known effect of administration of aerosolized epinephrine, which is caused by the oxidation of the sulphite stabilizer. This effect was not known to the investigators at the time of study design and is not in the drug monograph, but has been reported in a recent trial of epinephrine in the emergency department setting [ 14 ].

Because this could lead to unblinding of treatment allocation, an amendment to the study protocol was made for all subsequent patients whereby the bedside nurse wiped the nose of study participants after each study drug administration and immediately before the study nurse performed the daily respiratory assessment.

A nasopharyngeal aspirate for Respiratory Syncytial virus RSV antigen was routinely done in participating hospitals to determine appropriate placement for infection control purposes.

At the discretion of the attending physician, some children had respiratory tract samples submitted for respiratory virus culture RSV, influenza, parainfluenza, adenovirus.

A secondary outcome measure was duration of hospital stay, measured using a method previously validated by the Pediatric Investigators Collaborative Network on Infections in Canada studies of hospitalized children with RSV infection [ 15 ]. Each day the study nurse assessed which of four reasons accounted for ongoing hospitalization 1 patient receiving drug treatment for bronchiolitis 2 patient receiving oxygen supplementation or parenteral fluids because of bronchiolitis 3 patient hospitalized because of underlying pre-existing illness only or 4 awaiting transport home or uncertain home environment.

Only those days on which the reason for hospitalization were one or more of receiving medication for bronchiolitis 1 or oxygen supplementation or parenteral fluids because of bronchiolitis 2 , were recorded as valid hospital days. Discharge timing, counted as the time the decision was made to discharge home, was at the discretion of the attending physician.

Study personnel had no involvement in discharge planning and did not impose any discharge criteria. The interviewer read closed-ended questions from a standard script. Adverse events were collected during the hospital stay and during the post-discharge telephone call. The event was described and categorized according to severity mild, moderate, severe , outcome recovered fully, recovered with sequelae, ongoing, death and relationship to study drug related, probably or possibly related, unrelated, unable to classify.

The sample size was calculated to detect a difference in the RDAI score between day one and day three. The estimated sample size for a two-sample comparison of proportions of each group that achieved the four-unit difference was with a probability of type one error of 0. The standard deviations were based on previously reported changes in RDAI in bronchiolitis [ 13 ].

All randomized children were considered in the analysis. All analyses were performed using SAS 8. Proportions and exact binomial intervals were calculated for discrete variables and comparisons between treatment groups were made using the Fisher's exact test. Summary statistics mean, median, standard deviation, minimum and maximum were calculated for continuous variables and comparisons were made between treatment groups using the Wilcoxon rank-sum test.

Comparisons of trend across time were made using repeated measures analysis of variances. The RDAI was treated as a continuous measure.