Document Detail

Bronchodilators for bronchiolitis.
MedLine Citation:
PMID:  21154348     Owner:  NLM     Status:  MEDLINE    
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 Unpublished data were obtained from trial authors.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.
Anne M Gadomski; Melissa Brower
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2010-12-08
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2010  
Date Detail:
Created Date:  2010-12-14     Completed Date:  2011-02-10     Revised Date:  2014-07-03    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD001266     Citation Subset:  IM    
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MeSH Terms
Acute Disease
Ambulatory Care / statistics & numerical data
Bronchiolitis / drug therapy*
Bronchodilator Agents / therapeutic use*
Hospitalization / statistics & numerical data
Randomized Controlled Trials as Topic
Reg. No./Substance:
0/Bronchodilator Agents
Update In:
Cochrane Database Syst Rev. 2014;6:CD001266   [PMID:  24937099 ]
Update Of:
Cochrane Database Syst Rev. 2006;(3):CD001266   [PMID:  16855963 ]

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