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Abstract

RSV = respiratory syncytial virus; t PTEF /t E = exhaled time to reach peak expiratory flow as a fraction of total expiratory time; V maxFRC = maximal flow at functional residual capacity produced by forced expiration as a result of a rapid chest compression; V PTEF /V E = tidal volume exhaled at peak tidal expiratory flow as a fraction of total tidal volume.Available online http://ccforum.com/content/6/2/111In this issue of Critical Care, Totapally and colleagues [1] evaluate the effect of albuterol on tidal breathing loops of 20 infants with respiratory syncytial virus (RSV) bronchiolitis. They found that the wheeze score and the pulmonary function tests were not significantly affected by albuterol. This is the latest of 12 randomised controlled trials in 12 years [2][3][4][5][6][7][8][9][10][11][12], involving 843 infants, that evaluated the effect of bronchodilators on bronchiolitis. After so many trials, have we resolved whether bronchodilators have a role in the management of bronchiolitis, and have pulmonary function measurements been helpful? Salbutamol, albuterol and ipratropium bromideOf the 12 most recent randomised controlled trials published in English, evaluating the effect of salbutamol or albuterol on bronchiolitis, nine (75%) showed that bronchodilators had no effect. In three of these studies, some difference had been observed [3,11,12], yet it resulted in only a small transient improvement in the acute clinical score and had no effect on hospital admission rates or duration of stay in hospital. In one of these three studies [11], ex-premature infants who might have had some mild underlying chronic lung disease, which might have resulted in the response to bronchodilators, were not excluded. Several studies reported an increase in heart rate [12] or a decrease in oxygen saturation [3] after salbutamol or albuterol.The effect of ipratropium bromide (either alone or in combination with salbutamol or albuterol) on bronchiolitis has been evaluated in four recent randomised controlled trials [5,6,9,13] and none has shown any significant effect. Nebulised adrenalineIn contrast, there have been five published randomised controlled trials in the last 10 years, involving 225 infants, evaluating the effect of nebulised adrenaline (epinephrine) on bronchiolitis [7,[14][15][16][17]. All five (100%) have shown significant clinical improvement in infants with bronchiolitis, with decreases in oxygen requirement, respiratory rate, wheeze and retractions. Menon [14] showed lower hospital admission rates, and Bertrand et al. [15] AbstractOver the past 12 years there have been 12 randomised control trials, involving 843 infants, evaluating the effect of salbutamol or albuterol on bronchiolitis. Of these, nine (75%) showed that bronchodilators had no effect. In three studies a small transient improvement in the acute clinical score was seen. Ipratropium bromide had no significant effect. There have been five recent randomised trials involving 225 infants, evaluating the effect of nebulised adrenaline (epinephrin...

Efficacy of Salbutamol and Ipratropium Bromide in the Management of Acute Bronchiolitis – A Clinical Trial

“…In a recent review, 9 of 12 randomized controlled trials showed that bronchodilators had no effect [9]. In studies suggesting that β 2 -agonists are effective, conclusions are based on improvement in clinical scores but generally do not show any effect on duration of hospitalization similar to our study.…”

Viral Respiratory Infection and the Link to Asthma

“…69,70 Given the high costs and uncertain benefit of this therapy, bronchodilators are not recommended for routine management of first time wheezers. In children with established asthma, bronchodilators are first-line therapy for acute respiratory symptoms whether or not viruses are the cause.…”