Authors: doctor Adnan Alrawahi , doctor Alya Al Kindi , Basma Al Jabri , Hana Al Ghussaini , Sufyan AL Rahbi , Lubna AL Lawati

Abstract

Importance
Asthma exacerbations are a leading cause of emergency department (ED) visits and hospitalizations in children. Optimizing acute management is essential to improve outcomes and reduce healthcare utilization.

Objective
To determine whether nebulized epinephrine, when added to standard salbutamol therapy, improves PRAM (Pediatric Respiratory Assessment Measure) scores in pediatric patients with moderate to severe asthma exacerbations.

Design, Setting, and Participants
Double-blind, randomized controlled trial at tertiary care centers. Children aged 3 to 12 years with moderate to severe asthma exacerbations were randomized to receive either nebulized epinephrine plus standard salbutamol therapy or standard salbutamol therapy alone.

Interventions
Nebulized epinephrine in addition to standard salbutamol therapy versus standard salbutamol therapy alone.

Main Outcomes and Measures

Primary outcome: Change in PRAM score at 60, 80, and 100 minutes post-intervention.

Secondary outcomes: ED length of stay, hospital admission rates, ED revisit within 72 hours, and adverse events.

Results
Thirty children were randomized (15 per group). The mean change in PRAM score at 60 minutes was 2.1 (SD 1.2) for epinephrine and 2.0 (SD 1.1) for salbutamol (difference 0.1; 95% CI, –0.6 to 0.8; P = 0.78). At 80 minutes, the mean change was 2.7 (SD 1.3) vs 2.5 (SD 1.2) (difference 0.2; 95% CI, –0.5 to 0.9; P = 0.62), and at 100 minutes, 3.1 (SD 1.4) vs 2.9 (SD 1.3) (difference 0.2; 95% CI, –0.6 to 1.0; P = 0.64). No significant differences were observed in ED length of stay, hospital admission rates, or ED revisit rates within 72 hours. Adverse events were infrequent and similar between groups.

Conclusions and Relevance

Among children with moderate to severe asthma exacerbations, the addition of nebulized epinephrine to standard salbutamol therapy did not result in significant improvement in PRAM scores or secondary clinical outcomes compared with salbutamol alone. These findings support current guidelines recommending salbutamol as the primary therapy for acute pediatric asthma exacerbations and do not support routine use of nebulized epinephrine as an adjunct in this setting.

Trial Registration: ClinicalTrials.gov Identifier:  NCT05667727

Keywords: asthma, epinephrine