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Multicenter Study of Albuterol Use Among Infants Hospitalized with Bronchiolitis
Anna Condella1, Jonathan M Mansbach2, Kohei Hasegawa3
1Columbia University College of Physicians and Surgeons, Division of Pediatric Emergency Medicine, Department of Pediatrics, New York, New York.
Insights
Half of infants hospitalized for bronchiolitis received albuterol before admission, with use varying by age, prior treatment, and wheezing. Patient factors, not just local practice, influence bronchodilator use in infants.
Area of Science:
- Pediatrics
- Pulmonology
- Clinical Medicine
Background:
- Bronchiolitis is a frequent cause of infant hospitalization.
- Management of bronchiolitis shows significant heterogeneity.
- Current guidelines recommend against routine albuterol use in infants with bronchiolitis.
Purpose of the Study:
- To identify factors associated with pre-admission albuterol use in infants hospitalized for bronchiolitis.
- To analyze predictors of bronchodilator administration before hospital admission.
- To understand variations in bronchiolitis treatment.
Main Methods:
- Observational study of 1,016 infants (<1 year) across 17 centers (2011-2014).
- Pre-admission albuterol use determined by chart review (n=1,008).
- Multivariable logistic regression used to identify independent predictors of albuterol use.
Main Results:
- 50% of infants received pre-admission albuterol; use varied widely (23-84%) across hospitals.
- Independent predictors for albuterol use included: older age (≥2 months), prior bronchodilator use, and documented wheezing.
- Less likely to receive albuterol if symptom duration was ≥7 days or parent-reported fever.
Conclusions:
- Pre-admission albuterol use in bronchiolitis is influenced by both local practices and patient characteristics.
- Findings suggest potential subgroups of infants who might respond to albuterol, warranting further investigation.
- Supports current guidelines against routine albuterol but highlights need for nuanced understanding.
Introduction:
Although bronchiolitis is a common reason for infant hospitalization, significant heterogeneity persists in its management. The American Academy of Pediatrics currently recommends that inhaled albuterol not be used in routine care of children with bronchiolitis. Our objective was to identify factors associated with pre-admission (e.g., emergency department or primary care) use of albuterol among infants hospitalized for bronchiolitis.
Methods:
We analyzed data from a 17-center observational study of 1,016 infants (age <1 year) hospitalized with bronchiolitis between 2011-2014. Pre-admission albuterol use was ascertained by chart review, and data were available for 1,008 (99%) infants. We used multivariable logistic regression to identify infant characteristics independently associated with pre-admission albuterol use.
Results:
Half of the infants (n=508) received at least one albuterol treatment before admission. Across the 17 hospitals, pre-admission albuterol use ranged from 23-84%. In adjusted analysis, independent predictors of albuterol use were the following: age ≥2 months (age 2.0-5.9 months [odds ratio (OR) 2.09, 95% confidence interval (CI) {1.45-3.01}] and age 6.0-11.9 months [OR 2.89, 95% CI {1.99-4.19}]); prior use of a bronchodilator (OR 1.89, 95% CI [1.24-2.90]); and presence of wheezing documented in pre-admission chart (OR 3.94, 95% CI [2.61-5.93]). By contrast, albuterol use was less likely among those with ≥7 days since the start of breathing problem (OR 0.66, 95% CI [0.44-1.00]) and parent-reported fever (OR 0.75, 95% CI [0.58-0.96]).
Conclusion:
Variation in pre-admission albuterol use suggests that local practice had a strong influence on use, but that patient characteristics also influenced the decision. While we agree with current guidelines in recommending against albuterol for all infants with bronchiolitis, our understanding of possible subgroups of responders may improve through investigation of infants with the identified characteristics.
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