From the Guidelines
Albuterol should not be administered to infants and children with a diagnosis of bronchiolitis, as it does not provide significant benefits in terms of morbidity, mortality, or quality of life. Bronchiolitis is a viral lower respiratory tract infection that causes inflammation and mucus production in the small airways, and despite the wheezing that often occurs, the underlying pathophysiology differs from asthma 1. Multiple clinical trials and systematic reviews, including a recently updated Cochrane systematic review, have shown that albuterol does not significantly improve clinically important outcomes such as hospitalization rates, length of stay, or resolution of symptoms in most infants with bronchiolitis 1.
Some key points to consider when managing bronchiolitis include:
- The use of bronchodilators, including albuterol, has been extensively studied, and the evidence suggests that they do not provide significant benefits 1
- The potential adverse effects of albuterol, such as tachycardia and tremors, outweigh any potential benefits 1
- Management of bronchiolitis should instead focus on supportive care, including:
- Nasal suctioning
- Maintaining hydration
- Monitoring oxygen saturation
- Providing supplemental oxygen if oxygen saturation falls below 90-92%
- In certain specific cases, such as infants with underlying reactive airway disease, previous episodes of wheezing, or strong family history of asthma, a trial of albuterol might be considered, but only if there is documented clinical improvement 1.
It is essential to note that the evidence is clear, and the use of albuterol in bronchiolitis is not recommended, except in very specific cases, and even then, it should be used with caution and only if there is documented clinical improvement 1.
From the FDA Drug Label
Albuterol sulfate inhalation solution is indicated for the relief of bronchospasm in patients 2 years of age and older with reversible obstructive airway disease and acute attacks of bronchospasm. The FDA drug label does not answer the question.
From the Research
Patient Profile for Albuterol Use
- Older infants with rhinovirus (RV) bronchiolitis, especially those with a nasopharyngeal microbiome dominated by Haemophilus influenzae, may benefit from albuterol 2
- Infants affected during nonpeak months or during non-respiratory syncytial virus (RSV) predominant months may also benefit from albuterol 2
- Those with wheezing at presentation, clinical characteristics such as atopic dermatitis, or a family history of asthma in a first-degree relative may benefit from albuterol 2
- Infants infected with RSV genotypes ON1 and BA may have the greatest likelihood of benefiting from albuterol 2
Efficacy of Albuterol in Bronchiolitis
- A study found that nebulized ipratropium bromide added to nebulized albuterol resulted in no additional benefit in acute bronchiolitis 3
- Another study found that clinicians often continue to treat acute bronchiolitis with nebulized albuterol despite lack of clinical improvement 4
- A clinical trial found that salbutamol and ipratropium bromide improved clinical scores and oxygen saturation rates, but did not change the natural course of the disease 5
- A randomized, double-blind, placebo-controlled trial found that albuterol was as effective as oral placebo in the management of bronchiolitis 6
Combination Therapy
- The addition of ipratropium bromide to albuterol did not result in significant additional benefits in acute bronchiolitis 3
- Salbutamol and ipratropium bromide improved clinical scores and oxygen saturation rates, but the combination did not have a sufficient effect to change the natural course of the disease 5