Why Albuterol Is No Longer Used for Bronchiolitis

Bronchiolitis is a lower respiratory tract infection commonly occurring in children under 2. It is usually caused by the respiratory syncytial virus (RSV), which triggers inflammation of the smaller air passages (bronchioles), resulting in wheezing and shortness of breath. RSV can cause severe infections in premature babies and children. If your child is at risk for RSV infection, your pediatrician may discuss Synagis (palivizumab) or Beyfortus (nirsevimab) with you.

Palivizumab is a shot that can help protect certain infants and children 2 years old and younger who are at high risk of serious complications from RSV. It's typically given once a month during the RSV season. Palivizumab is not a vaccine, and it cannot cure or treat a child who is already diagnosed with RSV.

Beyfortus (nirsevimab) is approved for the prevention of RSV in newborns and babies born during or entering their first RSV season and in children up to 24 months who are at risk for severe RSV disease during their second RSV season. Beyfortus is a shot given once before or during the RSV season. 

Bronchiolitis is the leading cause of hospitalization in infants and young children. Since there is no cure for bronchiolitis, treatment is primarily aimed at alleviating symptoms of fever and breathing difficulties. If hospitalization is required, the treatment may also include supplemental oxygen and intravenous fluids to prevent dehydration.

In the past, the drug albuterol was commonly used in hospitals to help the child breathe. Albuterol is classified as a bronchodilator that works by relaxing muscles in the air passages. It is available in inhaled, oral, and injectable formulations and is commonly prescribed to people with chronic obstructive pulmonary disease (COPD) and asthma.

Why the AAP Advises Against Albuterol

In their updated 2014 recommendations, the AAP acknowledged that albuterol can provide transient relief in children with bronchiolitis in the same way that it does asthma. However, the actual effectiveness of the drug in this scenario was largely subjective.

Research published in 2013 has shown that the use of albuterol in hospitalized children did nothing to improve outcomes or reduce hospital stays. Moreover, the AAP recommends against other treatments commonly used in the past, including nebulized hypertonic saline, systemic corticosteroids, antibiotics, and chest physiotherapy.

When to Go to the Hospital

Bronchiolitis in children will usually develop after two to three days of the common cold. It typically starts with nasal congestion and discharge, a mild cough, and a fever over 100.4 F.

If the infection progresses and the lower air passages are involved, the condition can become serious and lead to symptoms of:

• Rapid breathing
• Wheezing
• Persistent coughing
• Difficulty feeding
• Gaps in breathing (apnea)

A parent will know that it's time to take the child to the emergency room if the wheezing lasts for more than seven days or progresses to grunting.

Another indication that a trip to the ER is warranted is if a child is using the muscles between the ribs or at the neck to take in breaths, is belly breathing (meaning the belly is going up and down severely with each breath), or cannot complete sentences without taking breaths in-between.

Current Hospital Recommendations

Approximately 2-3% of all children will require hospitalization for bronchiolitis. Treatment involves the monitoring of vital signs and supportive care based on the child's condition and symptoms.

Supplemental oxygen may be needed for children who are unable to catch their breath. This is usually done by placing a tube, called a nasal cannula, under a child's nose or by using a face mask. For infants, an oxygen headbox may be used.

If the child is unable to eat or drink, either because the respiratory rate is too fast or breathing is severely impaired, fluids and nutrition may need to be delivered intravenously (into a vein).To prevent the spread of the virus, the child would be isolated from siblings and other children until the condition is fully resolved.

Most children hospitalized for bronchiolitis are well enough to return home after three to four days.