Related Experiment Video
Updated: Jun 6, 2026
Methodology for Sputum Induction and Laboratory Processing
Published on: December 17, 2017
Bronchodilators for bronchiolitis
Anne M Gadomski1, Melissa Brower
1Research Institute, Bassett Medical Center, 1 Atwell Road, Cooperstown, New York, USA, 13326.
Insights
Bronchodilators do not improve oxygen saturation or reduce hospitalizations in infants with bronchiolitis. While slight clinical score improvements were noted, they must be weighed against potential adverse effects.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Evidence-Based Medicine
Background:
- Bronchiolitis is a common viral lower respiratory tract infection in infants.
- Treatment often involves bronchodilators, but their efficacy is debated.
Purpose of the Study:
- To evaluate the effectiveness of bronchodilator therapy in infants diagnosed with acute bronchiolitis.
- To assess the impact on key clinical outcomes such as oxygen saturation and hospitalization rates.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) comparing bronchodilators with placebo.
- Searched multiple databases including CENTRAL, MEDLINE, and EMBASE.
- Data extraction and quality assessment performed by two independent reviewers.
Main Results:
- Bronchodilators did not significantly improve oxygen saturation in hospitalized or outpatient settings.
- No reduction in hospitalization rates for outpatients or duration of stay for inpatients was observed.
- A slight improvement in clinical scores was noted, particularly in outpatients, but heterogeneity was significant.
Conclusions:
- Bronchodilator use in infants with bronchiolitis does not improve oxygen saturation or reduce hospital admissions or length of stay.
- Potential benefits of slight clinical score improvement are outweighed by costs and adverse effects like tachycardia and tremors.
Background:
Bronchiolitis is an acute, viral lower respiratory tract infection affecting infants and often treated with bronchodilators.
Objectives:
To assess the effects of bronchodilators on clinical outcomes in infants with acute bronchiolitis.
Search Strategy:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1) which contains the Acute Respiratory Infections Group's Specialized Register, MEDLINE (1966 to March week 2 2010) and EMBASE (2003 to March 2010).
Selection Criteria:
Randomized controlled trials (RCTs) comparing bronchodilators (other than epinephrine) with placebo for bronchiolitis.
Data Collection And Analysis:
Two authors assessed trial quality and extracted data. Unpublished data were obtained from trial authors.
Main Results:
We included 28 trials (1912 infants) with bronchiolitis. In 10 inpatient and 10 outpatient studies, oxygen saturation did not improve with bronchodilators (mean difference (MD) -0.45, 95% confidence interval (CI) -0.96 to 0.05, n = 1182). Outpatient bronchodilator treatment did not reduce the rate of hospitalization (12% in bronchodilator group versus 16% in placebo, odds ratio (OR) 0.78, 95% CI 0.47 to 1.29, n = 650). Inpatient bronchodilator treatment did not reduce the duration of hospitalization (MD 0.06, 95% CI -0.27 to 0.39, n = 349). In seven inpatient and eight outpatient studies, average clinical score decreased slightly with bronchodilators (standardized mean difference (SMD) -0.37, 95% CI -0.62 to -0.13, n = 1006).Oximetry and clinical score outcomes showed significant heterogeneity. Including only studies at low risk of bias significantly reduced heterogeneity measures for oximetry (I(2) statistic = 17%) and average clinical score (I(2) statistic = 26%), while having little impact on the overall effect size of oximetry (MD -0.38, 95% CI -0.75 to 0.00, P = 0.05) and average clinical score (SMD -0.26, 95% CI -0.44 to -0.08, P = 0.005).Effect estimates for outpatients were slightly larger than for inpatients for oximetry (outpatients MD -0.57, 95% CI -1.13 to 0.00 versus inpatients MD -0.29, 95% CI -1.10 to 0.51) and average clinical score (outpatients SMD -0.49, 95% CI -0.86 to -0.11 versus inpatients SMD -0.20, 95% CI -0.43 to 0.03). Adverse effects included tachycardia and tremors.
Authors' Conclusions:
Bronchodilators do not improve oxygen saturation, do not reduce hospital admission after outpatient treatment, do not shorten the duration of hospitalization and do not reduce the time to resolution of illness at home. The small improvements in clinical scores for outpatients must be weighed against the costs and adverse effects of bronchodilators.
Related Concept Videos
01:25Antiasthma Drugs: β2-Adrenoceptor Agonists
One class of bronchodilators includes β2-adrenoceptor agonists. These agents target the β2-adrenoceptors located on bronchial smooth muscle cells. By stimulating these receptors, β2-agonists induce relaxation in these...
01:17Drugs Used in Lower Respiratory Disorders: Overview
Bronchodilators, the first step of respiration enhancement, come in various forms, each with its own mechanism...
01:23Inhaled Medications
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:24Antiasthma Drugs: Methylxanthines
Theophylline is thought to inhibit phosphodiesterase enzymes, increasing intracellular levels of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). This rise in cAMP and cGMP concentrations stimulates cardiac function,...