Nebulized albuterol in acute bronchiolitis

American Family Physician,  Feb, 1991  

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The use of bronchodilators, such as sympathomimetic agents, theophylline and anticholinergic agents, in the treatment of acute bronchiolitis is somewhat controversial. Schuh and colleagues evaluated the clinical response to nebulized albuterol in infants and young children with acute bronchiolitis in a double-blind, placebo-controlled trial.

Forty children between six weeks and 24 months of age with their first episode of wheezing and other signs and symptoms of bronchiolitis were randomly assigned to receive either nebulized albuterol (0.15 mg per kg per dose) or placebo (saline solution) for two administrations, one hour apart. Complete physical examination was performed in all of the children. Temperature and vital signs were recorded. Assessment included an accessory muscle score and a wheeze score. Accessory muscle use was rated in the following manner: 0, no indrawing; 1, mild intercostal indrawing; 2, moderate indrawing with tracheostemal retractions, and 3, severe retractions with nasal flaring. Wheezing was rated in the following manner: 0, no wheezing; 1, end-expiratory wheezing only; 2, wheezing during entire expiratory-inspiratory phase (audible with a stethoscope only), and 3, inspiratory and expiratory wheezing (audible without a stethoscope). Oxygen saturation was measured by pulse oximetry.

One dose of albuterol resulted in significant improvement in the accessory muscle score and in oxygen saturation. After two doses, an improvement in accessory muscle score, respiratory rate and oxygen saturation was evident. The heart rate rose slightly more in the albuterol group than in the placebo group. This increase was clinically insignificant. No other side effects were noted.

Nasal swab specimens were obtained for viral identification in 34 of the children; 24 (71 percent) had positive results (21 for respiratory syncytial virus and one each for parainfluenza, paramyxovirus and influenza A viruses).

The authors believe that nebulized albuterol is a safe and effective treatment for infants and children with bronchiolitis. However, an optimal dose of albuterol has not been established. Journal of Pediatrics, October 1990, vol. 117, p. 633.)

COPYRIGHT 1991 American Academy of Family Physicians
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