Salbutamol Dosing in Viral Bronchitis

Evidence Against Routine Use in Bronchiolitis

The American Academy of Pediatrics strongly recommends against administering albuterol (salbutamol) to infants and children with a diagnosis of bronchiolitis due to lack of consistent benefit in clinical outcomes 1
A Cochrane systematic review of 30 randomized controlled trials involving 1992 infants found no significant benefit in the clinical course of infants with bronchiolitis who received bronchodilators 1
The potential adverse effects (tachycardia and tremors) and cost of these agents outweigh any potential benefits 1
Studies have shown that bronchodilators may improve clinical symptom scores temporarily but do not affect disease resolution, need for hospitalization, or length of stay 1

For office or clinic settings, if a trial is attempted, albuterol/salbutamol is more appropriate than epinephrine 2, 3
Parameters to measure effectiveness should include improvements in wheezing, respiratory rate, respiratory effort, and oxygen saturation 2, 3
If there is documented clinical improvement, there may be justification for continuing the nebulized bronchodilator treatments 2, 3
In the absence of a clinical response, the treatment should not be continued 2, 3

For nebulized salbutamol in children: 5 mg or 0.15 mg/kg 4, 5
For MDI with spacer in children: 100 μg per actuation, with up to 20 actuations as needed 4, 5
For adults with acute bronchitis with wheezing: Consider 2-4 puffs (200-400 μg) via handheld inhaler four hourly for mild episodes 6
For moderately severe episodes in adults: 400 μg (4 puffs) via handheld inhaler four hourly 6

In adults with acute bronchitis, β2-agonist bronchodilators should not be routinely used to alleviate cough 7
However, in select adult patients with acute bronchitis and wheezing accompanying the cough, treatment with β2-agonist bronchodilators may be useful 7
A subgroup of patients with airflow obstruction at baseline and wheezing at the onset of illness may show some benefit 7

Document pre-therapy and post-therapy changes using an objective means of evaluation 2, 3
If no improvement is observed after a trial dose, treatment should be discontinued 2, 3
Be aware of potential side effects including tremor, nervousness, and shakiness which are more common in treatment groups 7

Potential adverse effects include tachycardia and tremors 1
In elderly patients, β-agonists may rarely precipitate angina; a first treatment should be supervised 6
Monitoring for side effects is particularly important in young children and infants 2, 3