- Dobson JV,
- Stephens-Groff SM,
- McMahon SR,
- Stemmler MM,
- Brallier SL,
- Bay C
To determine whether the utilization of albuterol by nebulization improves the physiologic or clinical outcome in hospitalized infants with moderate bronchiolitis.
A prospective, double-blind, placebo controlled, randomized clinical trial performed from December 1995, to March 1996. The population included 52 patients <24 months of age with a diagnosis of moderately severe, acute viral bronchiolitis, who were randomized to receive nebulized albuterol or saline placebo for 72 hours. There was a standardized protocol with primary outcome measures including improvement in oxygen saturation, as well as the time required to achieve discharge criteria, including appropriate oxygen saturation, reduction in accessory muscle use, and wheezing. An additional secondary outcome was the actual length of hospital stay. Adverse outcomes were also compared between treatment groups.
There was no significant difference in oxygen saturation between the albuterol- and placebo-treated patients at any time during the hospitalization, nor was there a difference in time to reach discharge criteria, length of hospital stay, or frequency of adverse outcomes.
Nebulized albuterol therapy does not appear to improve the recovery or reduce the severity of acute, moderate bronchiolitis in hospitalized infants.
These results are consistent with previous studies, however, no attempt was made to separate children on the basis of family history of atopy or immunoglobulin E (IgE), so as to determine if there was a selective effect of albuterol in those with a higher probability of reactive airway disease or asthma. Furthermore, no attempt was made to add supplemental therapy, ie, steroids, to determine if the combination might enhance the response to albuterol, particularly in the subset of patients who may have a family history of atopy or a high IgE. Nonetheless, the reviewer's conclusion stands that the routine use of albuterol as a means for reducing hospital days or the severity of illness in bronchiolitis is not supported by this study.