Pediatric Pulmonology zy 3:83-85 (1987) z Effects of Nebulized Fenoterol, Associated With lpratropium or Steroids, on the Heart Rate of Infants Under One Year of Age With Acute Wheezing Javier Mallol, MD,~ Ricardo Muiioz, PT,~ Hornero Puppo, PT,~ Victor Ulloa, PT,~ Olivia Toro, P~D,' Guido Girardi, m,lS4 and Luis Barrueto, MD,' Summary. zyxwvutsrqp The main objective of this study was to evaluate the effect of fenoterol alone or associated with ipratropium bromide or steroid on the heart rate in young children. Ninety-four infants less than 1 year of age were randomly allocated to receive nebulized fenoterol alone, fenoterol plus ipratropium bromide, fenoterol plus corticosteroids. or normal saline solution. An increase in heart rate was observed in all four groups. The increases were statistically significant (P < 0.001) in all three treatment groups, and no difference between them was observed (F = 0.65, NS). However, the heart rate remained within clinically acceptable limits. We conclude that nebulized fenoterol alone or combined with ipratropium or steroids can be safely used in the treatment of wheezy infants. Pediatr Pulmonol 1987;3:83-85. Key words: Separate vs combined medication; statistically incomparable effects; clini- cal safety. INTRODUCTION zyxwvutsrq Several studies have shown that aerosolized 6-adren- ergic agonists are the initial treatment of choice in the management of acute wheezing in children. ' Recently, it was reported that a P-agonist administered in combina- tion with the cholinergic antagonist ipratropium bromide (IB) produces greater bronchodilatation than either drug alone. 2.3 The same feature, more bronchodilator effect, has been observed when a 0-agonist and a corticosteroid were used t ~ g e t h e r . ~ The combination of P-agonist and IB is of particular interest in young infrants, as previous studies have suggested that IB may be a more effective bronchodilator than 0-agonists in this age group. The present study was designed to evaluate the effect of nebulized fenoterol, nebulized fenoterol and IB, and fenoterol used in combination with corticosteroids on the heart rate of young infants being treated for acute wheezing. MATERIALS AND METHODS Ninety-four infants less than one year of age, admitted to the respiratory unit during the winter of 1984, were randomly allocated to one of four treatment groups after informed consent was obtained. Group I was given neb- ulized fenoterol plus IB, group 2 received fenoterol alone, group zyxwvutsrqp 3 received fenoterol plus corticosteroids, and group 4 served as a control group receiving nebulized saline. If the clinical score of patients in the control group deteri- orated during the period of the study they were reas- signed to an active treatment group. 1987 Alan R. Liss, Inc. All infants studied had hyperinflation, wheezing, and prolonged expiration. The scoring system of Tal et at4 was used to provide an objective clinical evaluation. Only infants with moderate obstruction (clinical scores: 6-9) were included. No attempt was made to distinguish be- tween asthma and bronchiolitis. Infants with preexisting cardiopulmonary disease or those who required mechan- ical ventilation or prolonged oxygen therapy in the neo- natal period were excluded from the study. The dose for fenoterol was 0.03 ml/kg of a 0.5% solution and for IB 1 ml of 0.025% solution (250 zy pg). Corticosteroids were given as either prednisone, 2 mg/ kg/day in three divided doses orally, or parented dexa- methasone, 0.3 mg/kg/day in three divided doses. Nebulized medications were administered by a jet neb- ulizer, using a flow rate of 6 literdmin. Active medica- tions were diluted to 4 ml with normal saline and nebulized over 10-12 minutes. Four treatments and heart rate counts were administered within 24 hours. The humeral pulse (over the inside of the elbow joint) was recorded by the same observers immediately before From the Bronchopulmonary Unit' and Physical Therapy Unit.' Ex. Gonzilez Cones Children's Hospital; Public Health Department, Uni- versity of Chile, Southern Metropolitan Area;3 and University of Chile. Department of pediatric^.^ Santiago. Chile. Received January 31, 1976; (revision) accepted September 18. 1986. Address correspondence and reprint requests to Dr. J. Mallol, Hos- pital Infantii Ex. Gonzalez Cortes, Ramcin Subercaseaux 1534, San- tiago. Chile.