Abstract
To evaluate the effect of nebulized albuterol on tidal breathing flow-volume loops in infants with bronchiolitis due to respiratory syncytial virus. A randomized, double-blind, control study. Pediatric unit in a community teaching hospital. Twenty infants younger than 1 year of age (mean age, 5.8 +/- 2.8 months) with a first episode of wheezing due to respiratory syncytial virus bronchiolitis. Chloral hydrate (50 mg/kg) was administered orally for sedation. One dose each of nebulized albuterol (0.15 mg/kg in 3 ml saline) and saline (3 ml) were given at 6 hour intervals in a random order. Tidal breathing flow-volume loops were obtained before and after each aerosol treatment with a Neonatal/Pediatric Pulmonary Testing System (Model 2600; Sensor Medics, Anaheim, CA, USA). At the same time, the fraction of tidal volume exhaled at peak tidal expiratory flow (PTEF) to total tidal volume (VPTEF/VE), and the fraction of exhaled time at PTEF to total expiratory time (tPTEF/tE) were measured. The PTEF, the tidal expiratory flows at 10%, 25%, and 50% of the remaining tidal volume (TEF10, TEF25, and TEF50), and the wheeze score were also determined. There were no significant changes in VPTEF/VE and tPTEF/tE after albuterol or saline treatment. PTEF increased significantly both after albuterol and saline treatments but the difference between the two treatments was not significant (P = 0.6). Both TEF10 and the ratio of the tidal expiratory flow at 25% of the remaining tidal volume to PTEF (25/PT) decreased significantly (P < 0.05) after administration of albuterol. All other investigated variables were not significantly affected by aerosol administration. Nebulized albuterol in infants with mild bronchiolitis due to respiratory syncytial virus did not improve VPTEF/VE and tPTEF/tE but did decrease TEF10 and 25/PT.
Highlights
The use of inhaled bronchodilators to treat children with bronchiolitis remains controversial [1,2,3,4]
The purpose of the present study is to evaluate the effect of nebulized albuterol administration on tidal breathing flow-volume (TBFV) loops and wheeze scores in infants with bronchiolitis due to respiratory syncytial virus (RSV)
Patients admitted to the pediatric unit were eligible for the study if they met the following criteria: age younger than 1 year; first episode of wheezing; clinical features of bronchiolitis; and nasopharyngeal secretions positive for RSV as determined by enzyme immunoassay
Summary
The use of inhaled bronchodilators to treat children with bronchiolitis remains controversial [1,2,3,4]. The controversy may be the result of differences in study populations, in choice of bronchodilators, or in measured outcome variables between trials. It has been shown that analysis of flow-volume loops at tidal breathing is useful in evaluating lung function in infancy [5,6,7]. The ratio of the time to PTEF to total expiratory time (tPTEF/tE) and the ratio of the tidal volume at PTEF to total exhaled volume (VPTEF/VE) were correlated with conventional measurements of airway obstruction [8]
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