***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 BACKGROUND Experimental and clinical evidence suggests that respiratory syncytial virus ( RSV ) bronchiolitis is an immune mediated disease . Corticosteroids might therefore be effective in the treatment of RSV bronchiolitis . METHODS A r and omised double blind trial was conducted in children up to two years of age admitted to hospital with RSV bronchiolitis to compare prednisolone ( 1 mg/ kg/day orally for seven days ) with placebo . Variables used for the efficacy analysis were a daily symptom score and the length of time in hospital in the non-ventilated patients , and the duration of mechanical ventilation and the length of time in hospital in the ventilated patients . RESULTS Fifty four patients were included in the trial , 40 of whom were non-ventilated ( 20 in each group ) and 14 were ventilated ( seven in each group ) . During the first three days of treatment the symptom score decreased significantly faster in the prednisolone group than in the placebo group ( mean ( SE ) decrease -1.2 ( 0.2 ) points/day versus -0.6 ( 0.2 ) points/day ; mean ( 95 % confidence interval ( CI ) ) for difference = -0.6 ( -0.1 to -1.2 ) ; p = 0.02 ) . The mean duration of hospital stay of all 40 non-ventilated patients was not significantly different between the two groups . In the ventilated patients the duration of mechanical ventilation was not significantly different , but the length of time in hospital was six days shorter in the prednisolone group than in the placebo group ( mean ( SE ) 11.0 ( 0.7 ) versus 17.0 ( 2.0 ) days ; mean ( 95 % CI ) difference = 7.0 ( 1.8 to 10.2 ) days ; p < 0.01 ) . CONCLUSIONS These results suggest that prednisolone may be effective in accelerating the clinical recovery of children admitted to hospital with RSV bronchiolitis 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 The efficacy of dexamethasone therapy for primary respiratory syncytial virus bronchiolitis was studied in a double-blind placebo design in 29 previously healthy infants ( median age , 194 days ) . No significant differences were found between the groups in evolution of respiratory rate , oxygen saturation , clinical score , or pulmonary function tests on day 3 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 BACKGROUND The role of bronchodilators in the treatment of bronchiolitis remains controversial . METHODS A double-blind , placebo controlled trial was performed to evaluate the clinical response to nebulized salbutamol .  One hundred and fifty-six infants aged between 7 weeks and 24 months who had had an episode of wheezing and other signs and symptoms of bronchiolitis were r and omized to three groups as follows : ( i ) nebulized salbutamol was administered to 52 patients in group I at a dose of 0.15 mg/kg in 2 mL saline ; ( ii ) saline was nebulized to 52 patients in group II and ( iii ) in group III 52 patients received mist in a tent . All three groups were administered oxygen during the procedures . Treatment was repeated with the same agent after 30 min if the respiratory score was 5 or more . Respiratory rate , heart rate , oxygen saturation and presence of cyanosis , wheezing , retractions were recorded before and after each treatment . RESULTS The decrease in the respiratory score was 5.2 + /- 1.8 , 0.82 + /- 2.4 and 1.7 + /- 1.3 in group I , II and III , respectively . The decrease in group I was significantly higher than in the other groups . Heart rate was similar between groups . Oxygen saturation decreased in group I without reaching statistical significance . CONCLUSIONS Salbutamol was shown to be effective and safe in the treatment of acute bronchiolitis A r and omised double blind placebo controlled trial of treatment with an aerosolised antiviral agent , ribavirin , was conducted in 26 infants with clinical ly diagnosed bronchiolitis .  Nebulised ribavirin ( 14 infants ) or normal saline aerosol ( 12 infants ) was given for 18 hours a day for at least three days . Respiratory syncytial virus was identified in nasal secretions from 20 cases ( 10 from both groups ) . Trends in seven out of eight clinical variables favoured active treatment . Ribavirin aerosol was associated with significantly faster improvement in cough and crepitations and more rapid rate of fall in respiratory and heart rates . In the 20 infants from whose nasal secretions respiratory syncytial virus was identified most variables favoured treatment with ribavirin , with significant reduction in chest recession . No difference was found in the rate of clearance of respiratory syncytial virus . The treatment was well tolerated as judged clinical ly and from the results of haematological and biochemical studies . The study suggests nebulised ribavirin may have a place in the treatment of some cases of bronchiolitis This r and omized , double-blind trial compared the efficacy of nebulized epinephrine with salbutamol in the treatment of infants with acute bronchiolitis . The mean percent oxygen saturation at 60 minutes was significantly higher in the epinephrine group . Thirty-three percent of the patients in epinephrine group were admitted to the hospital compared with 81 % of the salbutamol group ( p = 0.003 ) . We conclude that nebulized epinephrine is more efficacious than salbutamol for infants with acute bronchiolitis seen in an emergency department A double-blind r and omized placebo-controlled trial was conducted to investigate the efficacy of 3 months ' inhaled steroids delivered via a spacer device with face mask attachment to infants recovering from bronchiolitis . Forty-eight previously healthy infants recovering from their first documented episode of acute bronchiolitis were r and omized to receive 150 microg fluticasone propionate ( FP ) b.i.d . or placebo delivered via the Babyhaler spacer . Longitudinal assessment s were performed on seven occasions over 1 yr based on symptom diaries and health records , clinical examinations , overnight cough recordings and oxygen saturation readings . Lung function was measured 6 months after hospital discharge . Forty-three infants completed the trial  ( FP 21 , placebo 22 ) . There were no significant differences in the three objective end-points measured , recorded night cough , oxygen saturation and lung function test results . Symptom scores were low in both the FP and placebo groups with the absence of ( 0 ) or mild ( 1 ) symptoms > or = 90 % of the trial days . No statistical differences in symptom frequency , use of rescue respiratory medications or hospital admissions between treatment groups were found throughout the trial or follow-up periods . In conclusion , the use of inhaled fluticasone propionate in infants recovering from acute bronchiolitis can not be recommended To test the efficacy of a combined alpha- and beta-receptor agonist in acute bronchiolitis , we compared inhaled racemic epinephrine with salbutamol in a double-blind , crossover , r and omized protocol . Twenty-four infants , 4.6 + /- 0.5 ( mean + /- SEM ) months of age , with their first episode of bronchiolitis were tested . After sedation with chloral hydrate , a clinical score and pulmonary mechanics measurements using simultaneous signals of airflow volume and transpulmonary pressure were recorded . After baseline measurements , infants received either nebulized salbutamol , 0.03 ml/kg , or racemic epinephrine , 0.1 ml/kg . Thirty minutes later , there was a significant decrease in clinical score after treatment with racemic epinephrine compared with the baseline score ( p < 0.001 ) ; this difference was not present after salbutamol inhalation ( p = 0.42 ) . Only 13 patients had a decrease in clinical score after salbutamol therapy , in comparison with 20 infants treated with racemic epinephrine ( p < 0.01 ) . Both drug decreased respiratory rate , but the decrease was greater after the use of racemic epinephrine ( p < 0.001 ) . There was a significant decrease in inspiratory , expiratory , and total pulmonary resistance after treatment with racemic epinephrine compared with baseline values ( p < 0.01 ) but no significant change after salbutamol inhalation . There was no significant correlation between the clinical score and pulmonary mechanics either at baseline or after drug treatment . We conclude that racemic epinephrine is superior to salbutamol in the treatment of infants with their first episode of acute bronchiolitis Follow-up studies have demonstrated that bronchiolitis caused by respiratory syncytial virus ( RSV ) is strongly associated with wheezing in the ensuing years . During the acute infection the immune response may induce long-lasting detrimental effects , thereby contributing to  post-bronchiolitis wheezing ( PBW ) . Therefore , immune 
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CONCLUSIONS Overall , little evidence supports a routine role for any of these drugs in treating patients with bronchiolitis .