PEDIATRICS Vol. 100 No. 2 August 1997, pp. 233-239
Efficacy of 
2-Agonists in Bronchiolitis: A
Reappraisal and Meta-analysis
Received Jan 31, 1996; accepted Jul 26, 1996.
From the * Division of General Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, and the § Department of Internal Medicine and Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut.
Objective. To evaluate the efficacy
of 
2-agonists in bronchiolitis.
Design. Critical review and meta-analysis of randomized
controlled trials of inhaled 2-agonists.
Results. Three inpatient and five outpatient studies were identified. Inpatient studies (82 patients) were characterized by wide variability in therapeutic regimens and measurement of outcomes. Several problems were identified in the selection and specification of patients, such as failure to assess the prestudy duration of illness or to exclude patients already taking bronchodilators. Meta-analysis was not possible for inpatient trials due to the great variability in study outcomes, timing of outcome assessment, and drug regimens. Results of inpatient trials were contradictory: one found significant reductions in the clinical score and a shorter hospital stay with treatment, whereas two others found only significant oxygen desaturations.
Outpatient studies (251 patients) examined immediate changes in
physiologic measures and clinical scores after two treatments, but have
not examined the effects of the longer-term regimen customarily used by
clinicians. Meta-analysis revealed that short-term
2-agonist therapy had no impact on the hospitalization
rate or respiratory rate, and had a statistically significant but
clinically insignificant impact on oxygen saturation and heart rate.
The diversity of scoring systems precluded pooling of clinical score
data.
Conclusions. Despite eight clinical trials, conclusive
evidence for the efficacy of 2-agonist therapy for
bronchiolitis remains unavailable. Well-designed inpatient trials are
needed. Meta-analysis of outpatient studies does not support the use of
2-agonist therapy for bronchiolitis, but investigators
have not studied the outcomes and the long-term outpatient regimen
customarily used by clinicians.
2-agonists,
meta-analysis,
clinical trials,
infants.
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