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Bronchodilators for Bronchiolitis

 


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Am Fam Physician. 2015 Sep 1;92(5):online.

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BRONCHODILATORS FOR BRONCHIOLITIS

Number needed to treat or harm = None were helped
BenefitsHarms

None were helped (improved oxygen saturation)

Uncertain (decreased oxygen saturation)

None were helped (decreased rate of hospitalization)

Uncertain (tachycardia)

None were helped (duration of hospitalization)

BRONCHODILATORS FOR BRONCHIOLITIS

Number needed to treat or harm = None were helped
BenefitsHarms

None were helped (improved oxygen saturation)

Uncertain (decreased oxygen saturation)

None were helped (decreased rate of hospitalization)

Uncertain (tachycardia)

None were helped (duration of hospitalization)

Details for This Review

Study Population: Infants up to 12 months of age without a history of wheezing

Efficacy End Points: Improved oxygen saturation, rate of hospitalization, duration of hospitalization

Harm End Points: Decreased oxygen saturation, tachycardia

Narrative: Bronchiolitis is a common viral infection of childhood that is most often caused by respiratory syncytial virus. Bronchiolitis causes significant inflammation in the lower respiratory tract, which leads to large amounts of secretions and debris that obstruct small airways leading to wheezing on examination. Although bronchiolitis is not caused by the same mechanism that leads to wheezing in asthma, the similarity in presentation has led to the common use of bronchodilators to treat bronchiolitis.1

Clinical trials of bronchodilators to treat bronchiolitis have yielded varied results over the past several decades. The lack of clarity about the efficacy of bronchodilators has led to widespread continued use. This review included 30 randomized, placebo-controlled trials with a total of 1,922 patients.2 Trials evaluating treatment with epinephrine were not included in this version of the review. Twenty-two of the trials excluded patients with prior wheezing in an effort to minimize the number of patients with asthma in the sample. Most of these studies had relatively small sample sizes.

In 11 inpatient and 10 outpatient studies, oxygen saturation did not improve with bronchodilators (mean difference [MD] in oxygen saturation = −0.43%; 95% confidence interval [CI], −0.92 to 0.06; n = 1,242). This did not change when the analysis was limited to only the nine studies that used nebulized albuterol or salbutamol (MD = −0.19%; 95% CI, −0.59 to 0.21; n = 572).

The use of bronchodilators in outpatients did not reduce the rate of hospitalization to a statistically significant degree (11.9% in

Author disclosure: No relevant financial affiliations.

REFERENCES

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1. Nair H, Nokes DJ, Gessner BD, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375(9725):1545–1555....

2. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2014;(6):CD001266.

3. Klassen TP, Rowe PC, Sutcliffe T, Ropp LJ, McDowell IW, Li MM. Randomized trial of salbutamol in acute bronchiolitis [published correction appears in J Pediatr. 1991;119(6):1010]. J Pediatr. 1991;118(5):807–811.

4. Ho L, Collis G, Landau LI, Le Souef PN. Effect of salbutamol on oxygen saturation in bronchiolitis. Arch Dis Child. 1991;66(9):1061–1064.

5. Schweich PJ, Hurt TL, Walkley EI, Mullen N, Archibald LF. The use of nebulized albuterol in wheezing infants. Pediatr Emerg Care. 1992;8(4):184–188.

6. Hartling L, Bialy LM, Vandermeer B, et al. Epinephrine for bronchiolitis. Cochrane Database Syst Rev. 2011;(6):CD003123.

7. Ralston SL, Lieberthal AS, Meissner HC, et al.; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134(5):e1474–e1502.

8. American Academy of Family Physicians. Clinical practice guideline: bronchiolitis. http://www.aafp.org/patient-care/clinical-recommendations/all/bronchiolitis.html. Accessed March 22, 2015.

A collection of Medicine by the Numbers published in AFP is available at http://www.aafp.org/afp/



 

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