Inhaled salbutamol for wheezy infants: a randomised controlled trial

Abstract

Background-Salbutamol is frequently used as a bronchodilator for infants who wheeze. Many single dose studies have questioned its eVectiveness. Aims-To investigate the response of wheezy infants to salbutamol over an extended time period in order to elucidate either symptomatic relief or a protective eVect. Methods-Eighty infants under 1 year, with persistent or recurrent wheeze and a personal or family history of atopy, were recruited to a randomised, double blind, cross over, placebo controlled trial. Salbutamol (200 µg three times daily) or placebo were administered regularly over two consecutive treatment periods of four weeks via a spacer and mask. Symptoms of wheeze and cough were recorded in a diary. At the end of the study pulmonary function tests were performed before and after salbutamol (400 µg). Results-Forty eight infants completed the diary study; 40 infants underwent pulmonary function testing. No diVerence in mean daily symptom score was observed between the salbutamol and placebo periods. There was no diVerence in the number of symptom free days. Compliance and forced expiratory flows remained unchanged and resistance increased following salbutamol. There was no relation between the response measured by symptom score or pulmonary function in individual patients. Conclusion-In wheezy infants with an atopic background, there was no significant beneficial eVect of salbutamol on either clinical symptoms or pulmonary function. Clinical eVects could not be predicted from pulmonary function tests. Salbutamol cannot be recommended as the bronchodilator of choice in this age group.

Intravenous salbutamol for childhood asthma: evidence-based medicine?

“…Physiological measures of airway obstruction show that salbutamol does reduce airway obstruction in some with recurrent/persistent wheeze. However, most have no response to salbutamol or respond paradoxically 10 11. These findings support the presence of functional β2 adrenoreceptors and ASM in the very young.…”

Persistent wheezing in infants with an atopic tendency responds to inhaled fluticasone

“…The total study length was five months and families had already participated in the two month bronchodilator study 6. To have progressed this far, we considered the families were generally strongly motivated.…”

Bronchodilation in infants with malacia or recurrent wheeze

“…There are studies showing a beneficial effect of β 2 agonist treatment in wheezy infants, [1][2][3] studies showing no effect, [4][5][6][7] and studies showing an adverse effect. [8][9][10] It seems plausible that contradicting findings are a result of differences in lung function methodology, mode of aerosol administration, or aetiology of airway obstruction.…”