Please select the eligibility criteria that correspond to the clinical trial below.
Title: Randomized Controlled Trial of Epinephrine and Albuterol in Bronchiolitis
Brief Summary: The purpose of this study is to see which of the two most common drugs used to treat bronchiolitis works better. A child's participation in this study is expected to last less than 4 hours. Approximately 600 patients will be recruited to participate in this study at Kern Medical Center (KMC).

Bronchiolitis is a very common lung infection in babies. There are many drugs used to treat this disease but nobody knows which one, if any, works the best. Two of the most commonly used drugs are albuterol and epinephrine. These are both drugs given during breathing treatments with oxygen and a mask. We are doing this study to see which of these drugs works better or if they are both equally good. The study works as follows: after the consent process the baby gets three treatments.

* Nebulizer 1 (Treatment)
* Treatment + 30 minutes (approximately) Nebulizer 2
* Treatment + 60 minutes (approximately) Nebulizer 3
* Treatment + 120 minutes (approximately)

The baby will be reevaluated and either discharged home or revert to standard therapy. If the baby is discharged directly from the emergency department (E.D.), we will call you in three days time to see how he/she is doing.


Options:
A: Inclusion Criteria:

* Age 8 weeks through 23 months
* First episode of wheezing associated with respiratory distress and upper respiratory tract infection.
* Respiratory Distress Assessment Instrument (RDAI) rating of ≥4 and ≤15 after initial albuterol nebulization per standard care
* Pediatric Emergency Medicine (PEM) physician does not plan additional bronchodilator therapy within the hour after initial assessment.
* Parental/guardian permission (informed consent)

Exclusion Criteria:

* Subjects with prior history of wheezing or asthma or who have received bronchodilator therapy prior to the current illness
* Chronic lung or heart disease
* Critically ill infants requiring immediate airway stabilization
* Non-English speaking parent/guardian
* Inability to take nebulized medications
B: Inclusion Criteria:

* A clinical diagnosis of bronchiolitis

Exclusion Criteria:

* Age greater than 18 months
* Disease too mild to warrant any treatment
* Emergent intubation on arrival at the ED
* Participation within another study within 30 days
* Refusal of informed parental consent
C: Inclusion Criteria:

* Under one year of age
* first episode of wheezing and dyspnea
* RSV antigen detected by ELISA
* parents signed informed consent.

Exclusion Criteria:

* infants with chronic lung disease
* cardiac disease
* other chronic conditions.
D: Inclusion Criteria:

* Any child 2-12 months old seen in the emergency department.
* A clinical bronchiolitis score \> 3 by modified Wood's Clinical Bronchiolitis Score (M-WCBS).
* Diagnostic criteria of bronchiolitis includes tachypnea, cough, prolonged expiratory phase, wheezing, rales, chest retractions, and hyperinflation of lungs on chest radiograph. After consenting a patient to the study, respiratory syncytial virus (RSV) infection will be tested by rapid enzyme-linked immunoabsorbent assay of nasal secretions.

Exclusion Criteria:

* No child will be excluded based on race or gender
* Patients under the age of 2 months or greater than 12 months
* Patients with cyanotic heart disease
* Patients with lobar pneumonia, defined by results of chest radiographs.
* The presence of interstitial disease or diffuse patchy marking consistent with atelectasis on chest radiographs will not exclude patients.
* Patients with croup.
* Patients with foreign body aspiration.
* Patients with history of cystic fibrosis, bronchopulmonary dysplasia or other chronic lung disease.
* Patients with liver or renal disease.
* Patients with sickle cell anemia.
* Patients requiring mechanical ventilation.
* Patients who develop supraventricular tachycardia secondary to racemic epinephrine administration.
* Patients with tracheomalacia or bronchomalacia.
* Patients who had received bronchodilators within 2 hours of initiation of the study.
* Patients who had received systemic corticosteroids within 72 hours of enrollment
* Patients who suffered from persistent airway hyperreactivity in the 3 months before the study.
* Patients who do not tolerate the nasal cannulae for 45 out of 60 minutes.

Answer: B