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Early Use of Bronchodilators and Outcomes in Bronchiolitis

Kristen H Shanahan1,2, Michael C Monuteaux3,2, Joshua Nagler3,2

  • 1Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts kristen.shanahan@childrens.harvard.edu.

Pediatrics
|July 7, 2021
PubMed

Insights

Bronchodilator use in infants with bronchiolitis decreased significantly from 2010-2018. Early bronchodilator administration did not reduce hospital admissions or other adverse outcomes, supporting current guidelines.

Area of Science:

  • Pediatrics
  • Respiratory Medicine
  • Clinical Outcomes Research

Background:

  • Bronchiolitis is a common pediatric respiratory infection with no definitive preventative interventions.
  • The American Academy of Pediatrics advises against routine bronchodilator use for bronchiolitis.
  • Understanding trends and outcomes of bronchodilator use is crucial for evidence-based clinical practice.

Purpose of the Study:

  • To analyze trends in bronchodilator administration for infant bronchiolitis.
  • To evaluate the association between bronchodilator use and key clinical outcomes.
  • To assess the impact of hospital-level early bronchodilator use on patient outcomes.

Main Methods:

  • Multicenter retrospective study of 446,696 infant bronchiolitis emergency department (ED) visits (2010-2018).
  • Compared outcomes between hospitals with high vs. low early bronchodilator use.
  • Primary outcomes included hospital admissions, ICU admissions, ED return visits, and ventilation use.

Main Results:

  • Bronchodilator use, hospital admissions, and ED return visits declined significantly from 2010 to 2018.
  • Intensive care unit (ICU) admissions and ventilation use increased over the same period.
  • Hospital-level early bronchodilator use did not correlate with improved patient outcomes.

Conclusions:

  • Bronchodilator therapy for infant bronchiolitis has decreased, yet outcomes have not improved.
  • Early bronchodilator administration showed no association with reduced hospital admissions or need for ventilation.
  • Findings support the American Academy of Pediatrics' recommendation against routine bronchodilator use in this population.
Abstract

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