Efficacy of salbutamol in the treatment of infants with bronchiolitis

Abstract

Background: To systematically evaluate the clinical efficacy of salbutamol treatment in infants with bronchiolitis. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the use of salbutamol in infants with bronchiolitis was performed. The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of RCTs. Data were extracted and meta-analyzed using STATA version 12.0 (StataCorp, College Station, TX). Results: Thirteen RCTs, including a total of 977 participants, were assessed in the present meta-analysis. Results indicated that salbutamol therapy for bronchiolitis in infants led to an increase in respiratory rate (weighted mean difference [WMD] 2.26 [95% confidence interval {CI} 0.36–4.16]) and higher heart rate (WMD 12.15 [95% CI 9.24–15.07]). However, as a selective β2-agonist, salbutamol did not improve the clinical severity score of infants with bronchiolitis (WMD –0.11 [95% CI –0.26 to 0.03]), length of hospital stay (WMD 0.12 [95% CI –0.32 to 0.56]), or oxygen saturation (WMD 0.20 [95% CI –0.35 to 0.75]). Conclusion: Based on the results of this systematic review, the use of salbutamol had no effect on bronchiolitis in children <24 months of age. Moreover, the treatment can also lead to side effects, such as high heart rate. As such, salbutamol should not be recommended for treatment of bronchiolitis in infants.

Nebulized epinephrine versus salbutamol for the management of children presenting with bronchiolitis: Single Center Study.

“…And its use before this age can lead to adverse effects, such as high heart rate. 11 Similarly, studies have shown that the nebulized epinephrine is also not safe for routine use in infants with bronchiolitis. It should be considered in severe symptoms only.…”

The use of β2-adrenoreceptor agonists in viral bronchiolitis: scientific rationale beyond evidence-based guidelines

“…Additionally, a previous meta-analyses of the efficacy of bronchodilator therapy in viral bronchiolitis showed modest short-term improvements in older infants (>12 months) [56,57]. Unfortunately, more recent meta-analysis have failed to include age subgroup analyses to confirm these previous findings [22,58]. However, when analysing the results of studies included in the National Institute for Health and Care Excellence (NICE) guidance on the diagnosis and management of bronchiolitis that recruited children 24 months or younger (as compared to those studies that included younger infants) [59], β 2 -AR agonists use was associated with significant improvements in outcomes such as accessory muscle score, oxygen saturation, respiratory rate [60], clinical respiratory scores [61,62] and respiratory distress [63].…”

Comparison of Epinephrine and Salbutamol Nebulization in Acute Bronchiolitis in terms of mean change in RDAI Score

“…3 A meta-analysis showed that Beta 2-agonist therapy does not improve saturation of oxygen, does not lessen hospital stay, does not help in reducing hospitalization rate but can result in increased respiratory rate. 4 A trial conducted by Farooq A et al 5 in Islamabad showed that epinephrine could be a more effective treatment than salbutamol in the emergency management of acute bronchiolitis (mean RDAI score after 48 hours in the epinephrine group was 8.35±1.36 as compared to 10.07±1.37 in the salbutamol group). Another metaanalysis also showed the effectiveness and superiority of adrenaline over salbutamol.…”