Albuterol Virus: A Case Study

A Review of Albuterol use in Infants with Respiratory Virus Kaitlyn Coulter
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections such as bronchiolitis and pneumonia in pediatric patients [1]. RSV bronchiolitis affects infants between the ages of
0–3 months with greater severity [2]. The viral process impairs normal pulmonary gas exchange leading to ventilation-perfusion mismatch and subsequent hypoxemia. The care of infants with bronchiolitis is mostly supportive. The focus of therapy is providing supplemental oxygen as needed and intervening in regards to the infant’s hydration status, if feeding is impaired. Bronchodilators have been extensively studied to determine if they are useful in the
management of RSV bronchiolitis, with inconclusive results [2–4].
Bronchodilators continue to be used frequently in outpatient settings, for which there is some supportive data [5]. Far less data has been available in regards to the use of albuterol in the inpatient setting.
Wainwright et al. looked at the use of bronchodilators in admitted patients with bronchiolitis and found no significant difference in regards to LOS or hours on oxygen when comparing epinephrine use to placebo
[6]. In addition to the lack of data regarding use of bronchodilators for admitted patients with bronchiolitis, the wide variability of ages used in studies has led to confounding evidence.
The objective of Del Vecchio et al. was to evaluate the effects of albuterol use in young infants admitted with respiratory syncytial virus (RSV) bronchiolitis with regards to length of time on supplemental oxygen and length of stay (LOS). To consider the possibility that albuterol use may increase the need for supplemental oxygen and increase LOS. Full-term infants between the ages of 11 days and 90 days were included in the retrospective study. Infants included were hospitalized with a diagnosis of RSV bronchiolitis at a university-affiliated children’s hospital. Results in 4 of 5 severity groups, patients who received albuterol required more time on supplemental oxygen and had longer LOS. The differences only reached statistical significance in one of the severity groups in regards to LOS. The use of albuterol does not appear to be useful in the treatment of young infants with RSV bronchiolitis and may actually be harmful, in regards to increased supplemental oxygen need.
Given the limitations of the available data addressing the use of bronchodilators for treatment of young infants admitted to the hospital with RSV bronchiolitis the researcers undertook this study. They aimed to evaluate whether young infants treated with albuterol had an increased duration of supplemental oxygen needs when compared to young infants who did not receive albuterol. They considered that young infants treated with albuterol would be more likely to incur mismatch, leading to hypoxemia as measured by pulse oximetry, and increased length of time on supplemental oxygen. They also tested that an increase in length of time on supplemental oxygen would lead to an increased LOS.
The researchers conducted this study during a 5-year period (1999–2004) by reviewing medical records of all infants between the ages of 11 to 90 days admitted to the general pediatric service at Temple University
Children’s Medical Center in Philadelphia, Pennsylvania, USA. The patient criteria included full-term infants (>37 weeks gestation), RSV antigen positive by the rapid RSV test, and infants from 11 to 90 days of age. The criteria for not participating in the study were prematurity, cardiac or respiratory anomalies, use of corticosteroids during the course of hospitalization, other issues which could affect respiratory status such as croup, pertussis, influenza, and asthma, or a transfer to the intensive care unit during the course of hospitalization. A total of 419 patients were evaluated.
Of the total, 103 patients were excluded leaving 316 patients for analysis. 56% were male and average LOS was 2.47 days. In all severity groups except for one the mean number of hours on supplemental oxygen was longer for the albuterol groups versus the nonalbuterol groups. For the five severity groups which showed longer need of supplemental oxygen in the albuterol groups the increase in hours ranged from 3.4 to 21.6. None of the differences in the severity groups in regards to hours of supplemental oxygen reached statistical significance. In one of the severity groups the albuterol group had a shorter time of supplemental oxygen than the non-albuterol group. In all severity groups except for one the LOS was longer in the albuterol groups than in the non-albuterol groups. The increase in LOS for the severity groups receiving albuterol ranged from 0.41 days to 1.14 days. One of the groups reached statistical significance in regards to the increased LOS in the albuterol group. One severity group had a longer LOS in the non-albuterol group. This increase, though, was only 0.04 days. When all groups were taken together, statistical significance was not
reached.
Though use of bronchodilators in bronchiolitis remains controversial, most of the evidence addresses the lack of response, not possible negative outcomes. The present study adds to the existing evidence that, for young infants with RSV bronchiolitis admitted to the hospital, albuterol use is not helpful. Actually theses rsearchers have shown that bronchodilators may actually be harmful, leading to increase in time needed on supplemental oxygen and increased time spent in the hospital