- In bronchiolitis, terminal bronchiolar and alveolar inflammation with
airway swelling and luminal debris create airway obstruction.2
- Albuterol, a bronchodilator, may not provide significant improvement
in clinical course due to inadequate beta-agonist lung receptor sites
or immature bronchiolar smooth muscle development.1
- Prior to enrollment in the study, many patients received albuterol
in the Emergency Departmen. This may select out good responders and
patients who will develop asthma in the future.1,2
- The Cochrane Database of Systematic Reviews with a meta-analysis of
394 children with bronchiolitis showed only a modest short-term improvement
in clinical scores with use of bronchodilators, however the inclusion
of patients with history of recurrent wheezes may have biased the results
in favor of bronchodilators.2
- Minimal toxicity occurs with albuterol but may include tachycardia,
mild hypertension, hyperactivity, and tremor.2
- Nebulized saline may act as a pulmonary irritant and induce hypoxia
H, Platt RW, Pekeles GS, Ducharme FM. A randomized, controlled trial
of the effectiveness of nebulized therapy with epinephrine compared
with albuterol and saline in infants hospitalized for acute viral bronchiolitis.
J Pediatr 2002;141: 818-24.
JD, Ohlsson A, Gadomski AM, Wang EEL. Bronchodilators for bronchiolitis.
Cochrane Acute Respiratory Infections Group. Cochrane Database of Systematic
Reviews 4, 2004.