***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE In previously well infants hospitalized with acute viral bronchiolitis , the effectiveness of repeated nebulized therapy with epinephrine ( EPI ) was compared with treatment with albuterol ( ALB ) or saline placebo ( PLAC ) . STUDY DESIGN In this r and omized , double-blind , parallel-group , controlled trial , infants received study nebulizations every 1 to 6 hours and were assessed twice daily by the research team . The primary outcome was length of hospital stay ( LOS ) . Secondary outcomes included the time from admission until the infant had normal hydration , oxygenation , and minimal respiratory distress . RESULTS A total of 149 infants were r and omized ; 50 were allocated to receive racemic EPI , 51 were given ALB , and 48 received PLAC . Baseline characteristics and pre-enrollment symptoms , signs , and therapy were similar between groups . There were no group differences in the primary outcome measure , mean LOS (hours)(+/- SD ) : EPI = 59.8 ( 62 ) , ALB = 61.4 ( 54 ) , and PLAC = 63.3 ( 47 ) ; P = .95 by intent-to-treat analysis . Group differences were not statistically significant in any of the secondary outcomes . CONCLUSIONS There were no group differences in the effectiveness of therapy for infants hospitalized with bronchiolitis . Based on these results , we do not recommend routine use of either nebulized EPI or ALB in this patient group Objective To compare the length of hospital stay ( primary ) and improvement in clinical severity scores ( secondary ) among children with bronchiolitis nebulized with 3 % hypertonic saline or 0.9 % saline .  Design R and omized double blind controlled trial . Setting Tertiary care teaching hospital . Patients Hospitalized children ( 1–24 months ) with acute bronchiolitis of moderate severity . InterventionNebulization of 4 ml of 3 % hypertonic saline or 4 mL of 0.9 % saline , along with 2.5 mg salbutamol , at 4-hourly intervals till the patient was ready for discharge . Results Baseline characteristics were similar in two groups . Median clinical severity score at admission was 6 ( IQR-1 ) in both the groups . Clinical severity scores monitored afterwards 12-hourly till discharge ( 132 h ) did not show statistically significant differences in 3 % and 0.9 % saline groups . Mean length of hospital stay ( time to reach predefined clinical severity score<3 ) was 63.93 ± 22.43 h in 3 % saline group and 63.51 ± 21.27 h in 0.9 % saline group ( P=0.878 ) . No adverse events were reported by the parents , caregivers or treating medical attendants in both groups . Conclusion Nebulized 3 % saline is not superior to 0.9 % saline in infants with clinical ly diagnosed acute bronchiolitis Objective An appropriate treatment of acute viral bronchiolitis can reduce the symptoms , hospitalization duration and exorbitant costs which is imposed on the families and insurance organizations . This study was conducted to determine the efficacy of epinephrine in comparison with salbutamol in the treatment of the disease . Methods Forty infants aged one month to 2 years with acute bronchiolitis in Amin and Al-Zahra hospitals , during 2008 , were enrolled in this study . The participants were r and omized in two treatment groups to receive epinephrine 0.1 ml/kg or salbutamol 0.15 mg/kg . Three doses of each medication were prescribed at intervals of 20 minutes and continued every 10 minutes after the third dose . The patients in both groups were monitored and rated by RDAI , number of the hospitalized days in the hospital , level of oxygen saturation and vital signs . Findings Mean hospitalization duration was 3.3±1.1 and 3±0.9 in the patients receiving salbutamol and epinephrine , respectively ( P=0.03 ) . There was a significant difference in assessing RDAI index between the two groups ( P=0.03 ) . There were no differences in SPO2 , PR , or RR variables in the studied intervals in both groups ( P>0.05 ) . Conclusion Regarding the effect of epinephrine on reduction of hospitalization duration and the RDAI index in patients with acute bronchiolitis , it seems that using epinephrine instead of salbutamol could be more effective in the management of the disease OBJECTIVE To investigate whether nebulized racemic epinephrine or albuterol improves respiratory distress in infants with acute bronchiolitis . DESIGN A r and omized , placebo-controlled , double-blind study . SETTING A university hospital providing primary hospital care for all pediatric patients in a defined area . PATIENTS One hundred consecutive infants younger than 24 months treated in the hospital for acute bronchiolitis . INTERVENTION The patients received two inhalations at 30-minute intervals : racemic epinephrine followed by physiologic saline ( REP group ; n = 24 ) , albuterol followed by physiologic saline ( AP group ; n = 27 ) , physiologic saline followed by racemic epinephrine ( PRE group ; n = 24 ) , and physiologic saline followed by albuterol ( PA group ; n = 25 ) . All patients received intramuscular epinephrine 60 minutes after the beginning of the study . MAIN OUTCOME MEASURES Oxygen saturation , respiratory rate , and two clinical scores were used : one based on wheezing and retractions ( Respiratory Distress Assessment Instrument ) and the other based on changes in wheezing , retractions , and respiratory rate ( Respiratory Assessment Change Score ) . MAIN RESULTS During the study , there were no significant differences among the four groups in clinical scores , oxygen saturations , and respiratory rates . Mean Respiratory Distress Assessment Instrument scores improved significantly within the REP , PRE , and AP groups 15 minutes after the first inhalation . In only the REP group , which received racemic epinephrine , the confidence limits did not overlap . A comparison of paired data of each patient revealed that the difference in Respiratory Assessment Change Score was significant between racemic epinephrine and physiologic saline , but not between albuterol and physiologic saline . Intramuscular epinephrine significantly improved Respiratory Distress Assessment Index scores in those groups treated earlier with racemic epinephrine ( REP and PRE groups ) . No significant adverse effects were seen in any group or at any phase of the study . CONCLUSIONS Elimination of hypoxia by supplemental oxygen and moistening of inspired air relieve the symptoms of acute bronchiolitis . Nebulized racemic epinephrine and albuterol are safe and useful in the treatment of acute bronchiolitis . Improvements in symptom scores at 15 minutes favor the use of racemic epinephrine . As the action of epinephrine is short , the effect can be increased by repeated inhalations To evaluate combination therapy of mild to moderate bronchiolitis with bronchiodilators and corticosteroids , we treated 51 young children with first-time wheezing and symptoms of respiratory tract infection with  albuterol plus either prednisolone or placebo for 5 days . Disease severity was scored on days 0 , 2 , 3 , and 6 . On day 2 , prednisolone result ed in significantly lower scores ( 2.7 ±1.4 vs. 4.0 ±1.5 in all patients evaluated , p<0.05 ) than placebo , whereas there was no detectable difference on day 6 , suggesting that addition of prednisolone to albuterol transiently accelerates recovery from bronchiolitis . The clinical significance of this effect needs to be evaluated in further studies OBJECTIVE To determine the utility of inhaled hypertonic saline solution to treat ambulatory infants with viral bronchiolitis . DESIGN R and omized , double-blind , controlled trial . Sixty-five ambulatory infants ( mean + /- SD age , 12.5 + /- 6 months ) with viral bronchiolitis received either of the following : inhalation of 0.5 mL ( 5 mg ) terbutaline added to 2 mL of 0.9 % saline solution as a wet nebulized aerosol ( control ; group 1 ; n = 32 ) or 0.5 mL ( 5 mg ) terbutaline added to 2 mL of 3 % saline solution administered in the same manner as above ( treatment ; group 2 ; n = 33 ) . This therapy was repeated three times every day for 5 days . RESULTS The clinical severity ( CS ) scores at baseline on the first day of treatment were 6.4 + /- 1.8 in group 1 and 6.6 + /- 1.5 in group 2 ( not significant ) . After the first day , the CS score was significantly lower ( better ) in group 2 as compared to group 1 on each of the treatment days ( p < 0.005 ; Fig 1 ) . On the first day , the percentage decrease in the CS score after inhalation therapy was significantly better for group 2 ( 33 % ) than for group 1 ( 13 % ) [ p < 0.005 ; Fig 1 ] . On the second day , the percentage improvement was better in the hypertonic saline solution-treated patients ( group 2 ) as compared to the 0.9 % saline solution-treated patients ( group 1 ) [ p = 0.01 ; Fig 1 ] . CONCLUSIONS We conclude that in nonasthmatic , nonseverely ill ambulatory infants with viral bronchiolitis , aerosolized 3 % saline solution plus 5 mg terbutaline is effective in decreasing symptoms as compared to 0.9 % saline solution plus 5 mg terbutaline OBJECTIVE To determine the utility of inhaled hypertonic saline solution to treat infants hospitalized with viral bronchiolitis . DESIGN R and omized , double-blind , controlled trial . Fifty-two hospitalized infants ( mean + /- SD age , 2.9 + /- 2.1 months ) with viral bronchiolitis received either inhalation of epinephrine , 1.5 mg , in 4 mL of 0.9 % saline solution ( group 1 ; n = 25 ) or inhalation of epinephrine , 1.5 mg , in 4 mL of 3 % saline solution ( group 2 ; n = 27 ) . This therapy was repeated three times every hospitalization day until discharge . RESULTS The percentage improvement in the clinical severity scores after inhalation therapy was not significant in group 1 on the first , second , and third days after hospital admission ( 3.5 % , 2 % , and 4 % , respectively ) . In group 2 , significant improvement was observed on these days ( 7.3 % , 8.9 % , and 10 % , respectively ; p < 0.001 ) . Also , the improvement in clinical severity scores differed significantly on each of these days between the two groups . Using 3 % saline solution decreased the hospitalization stay by 25 % : from 4 + /- 1.9 days in group 1 to 3 + /- 1.2 days in group 2 ( p < 0.05 ) . CONCLUSIONS We conclude that in nonasthmatic , nonseverely ill infants hospitalized with viral bronchiolitis , aerosolized 3 % saline solution/1.5 mg epinephrine decreases symptoms and length of hospitalization as compared to 0.9 % saline solution/1.5 mg epinephrine OBJECTIVES Bronchiolitis is the most common disease of the lower respiratory tract in the first year of life . Treatment is controversial , with studies giving conflicting views on the benefits of bronchodilators and steroids . The objectives of this study were 1 ) to characterize the management of bronchiolitis in pediatric emergency departments ( PEDs ) in Canada , 2 ) to determine patient outcomes following emergency department ( ED ) visits , and 3 ) to provide descriptive data regarding bronchiolitis symptoms and family/personal medical history of these patients . METHODS A prospect i ve consecutive cohort of children with bronchiolitis presenting to seven Canadian PEDs was enrolled during a seven-to-21-day period . St and ardized interviews with parents provided data regarding symptoms , previous treatment , and past history . Charts were review ed for treatment , investigations , and disposition . Telephone follow-up at two to three weeks collected information regarding duration of illness and return visits . RESULTS Two hundred thirty-seven ( 91 % ) of 260 eligible patients were enrolled . One hundred eighty-nine patients ( 80 % ) had both an interview and chart review , and 48 ( 20 % ) had only chart review s ; follow-up was completed for 163 ( 69 % ) patients . One hundred fifteen ( 63 % ) had seen their primary care provider during their illness prior to the ED visit . Seventy-three percent of patients ( range per site 59 - 100 % ) were treated in the ED with bronchodilators ( usually salbutamol or epinephrine ) and 5 % ( range per site 0 - 14 % ) with oral steroids . Twenty-four percent ( 58/237 ) were prescribed bronchodilators on discharge , 3 % ( 7/237 ) inhaled steroids , and 2 % ( 5/237 ) oral steroids . Chi-square tests indicated significant practice variation by site in ED bronchodilator use ( p < 0.001 ) and bronchodilator use at discharge ( p = 0.0003 ) . Admission rate was 31 % ( range by site 22 - 43 % ) , 17 % of 
    Output:
    
Including only studies with low risk of bias reduced the heterogeneity but had little impact on the overall effect size of average clinical score ( SMD -0.22 , 95 % CI -0.41 to -0.03).Sub-analyses limited to nebulized albuterol or salbutamol among out patients ( nine studies ) showed no effect on oxygen saturation ( MD -0.19 , 95 % CI -0.59 to 0.21 , n = 572 ) , average clinical score ( SMD -0.36 , 95 % CI -0.83 to 0.11 , n = 532 ) or hospital admission after treatment ( OR 0.77 , 95 % CI 0.44 to 1.33 , n = 404).Adverse effects included tachycardia , oxygen desaturation and tremors .
AUTHORS ' CONCLUSIONS Bronchodilators such as albuterol or salbutamol do not improve oxygen saturation , do not reduce hospital admission after outpatient treatment , do not shorten the duration of hospitalization and do not reduce the time to resolution of illness at home .