Should We Use Bronchodilators for Bronchiolitis?

Written by Gabby Leonard

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For infants <12 months diagnosed with bronchiolitis, bronchodilators did not improve hospital or ICU admission numbers, ED return visits, or noninvasive or invasive ventilation requirement.

?Why does this matter
COVID has altered the typical summer respite from RSV, and cases have risen, leading to crowding in pediatric hospitals due to bronchiolitis in infants <12 months. Bronchiolitis is the most commonly diagnosed lower respiratory infection in infants, accounting for up to 300,000 visits per year in EDs. The American Academy of Pediatrics (AAP) recommendation from 2014 does not endorse the use of bronchodilators as part of routine treatment for bronchiolitis. Currently, there are no recommended interventions that are known to be effective at reducing hospital admission for bronchiolitis, which accounts for up to 18% of all pediatric admissions.

No summer break this year
This multicenter, retrospective, cross-sectional study reviewed over 445,000 ED visits between 2010-2018 to see if there was any clinical or statistical difference in outcomes regarding bronchiolitis with bronchodilator use. When comparing hospitals with the highest vs lowest rates of bronchodilator use, there was no difference in, “hospital admissions (OR: 0.93; 95% CI 0.7–1.3), ICU admissions (OR: 1.5; 95%CI 0.7–3.1), ED return visits after initial ED discharge (OR: 1.2; 95%CI 0.99–1.4), noninvasive ventilation (OR: 3.5; 95%CI 0.7–19.1), and invasive ventilation (OR: 8.2; 95% CI 0.99–67.5).” In addition, over the study period, hospital admissions decreased from 34.4% to 33.1% (OR 0.98, 95%CI 0.98-0.99) and ED return visits within 3 days decreased from 5.9% to 5.2% (OR 098, CI 95%CI 0.98-0.99) while ICU admissions increased from 2.4% to 4.3% (OR 1.06, 95%CI 1.05-1.06); noninvasive ventilation increased from 1% to 2.9% (OR 1.15, 95%CI 1.14-1.16), and invasive ventilation increased from 0.7% to 1.5% (OR 1.06, 95%CI 1.04-1.07).

In summary, supportive care and noninvasive or invasive ventilatory support, in conjunction with suctioning, are considered first-line therapies for bronchiolitis, and bronchodilators have not shown any clinically significant benefit in these patients.

Source
Early Use of Bronchodilators and Outcomes in Bronchiolitis. Pediatrics. 2021 Jul 6;e2020040394. doi: 10.1542/peds.2020-040394. Online ahead of print.

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