Do bronchodilators have an effect on bronchiolitis?
Over the past 12 years there have been 12 randomised control trials, involving 843 infants, evaluating the effect of salbutamol or albuterol on bronchiolitis. Of these, nine (75%) showed that bronchodilators had no effect. In three studies a small transient improvement in the acute clinical score was seen. Ipratropium bromide had no significant effect. There have been five recent randomised trials involving 225 infants, evaluating the effect of nebulised adrenaline (epinephrine) on bronchiolitis. All five (100%) have shown significant clinical improvement, with reductions in oxygen requirement, respiratory rate and wheeze after nebulised adrenaline. Two showed lower hospital admission rates and earlier discharge with adrenaline. A significant improvement in pulmonary resistance was observed after nebulised adrenaline but not after salbutamol or albuterol. Currently there is no compelling evidence that bronchodilators have a role in the routine management of infants with bronchiolitis. There is better evidence for the use of nebulised adrenaline.
Schindler
Margrid
M
Consultant, Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK. schinm@gosh.nhs.uk
D000420:Albuterol / Q000627:therapeutic use; D001988:Bronchiolitis / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D009241:Ipratropium / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012129:Respiratory Function Tests; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy*
D001993:Bronchodilator Agents; D009241:Ipratropium; D000420:Albuterol