Use of nebulized bronchodilators in infants under 1 year of age: Analysis of four forms of therapy

Abstract

The main purpose of this study was to evaluate four different forms of treatment in young infants admitted for acute wheezing (AW). Seventy-nine infants less than one year of age were randomly assigned to one of five groups. Group 1 received nebulized fenoterol plus ipratropium bromide, group 2 fenoterol, group 3 fenoterol plus steroids, and group 4 aminophylline, IV, plus steroids and oral fenoterol; the control group, or group 5, received nebulized normal saline solution. Clinical evaluation was done by means of a scoring system. The effectiveness of treatments was estimated by a score decrease in the first 24 hours, by the percentage of patients whose scores did not decrease during the same period, and by the number of days in the hospital. All infants had significantly decreased scores, except those in the control group; the aminophylline group included a greater percentage of patients who did not abate their scores, and they stayed in the hospital for more days than those in the other groups. The fenoterol group had the shortest hospital stay. All four treatments produced objective clinical improvement in bronchial obstruction. However, the nebulized bronchodilator treatments were more effective than aminophylline IV in decreasing scores on the first day, and they resulted in shorter hospitalization.

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

“…Several meta-analyses and systematic reviews [48][49][50][51][52][53] [57][58][59] are methodologically weaker than other studies and include older children with recurrent wheezing. Results of the Cochrane review indicated no benefit in the clinical course of infants with bronchiolitis who received bronchodilators.…”

Efficacy of bronchodilators administered by nebulizers versus spacer devices in infants with acute wheezing

“…[1][2][3][4][5][6] Much of this controversy is based on difficulties in interpreting the measurements of respiratory function at this age. [7][8][9] Nevertheless, based on clinical observations 1,2,10 bronchodilators given by inhalation are a first-line treatment for wheezing in most emergency departments. 11 In a hospital setting, they are usually administered by nebulizers.…”

Diagnosis and Management of Bronchiolitis

“…A Cochrane systematic review 44 found 8 RCTs involving 394 children. 33,[45][46][47][48][49][50] Some of the studies included infants who had a history of previous wheezing. Several used agents other than albuterol/salbutamol or epinephrine/adrenaline (eg, ipratropium and metaproterenol).…”