Tidal Breathing Responses to Albuterol and Normal Saline in Infants with Viral Bronchiolitis

Abstract

The American Academy of Pediatrics recommends the use of an objective means of evaluating the response to a trial of bronchodilator therapy in viral bronchiolitis (VB), but there is an inherent subjectivity with the use of clinical assessments. The goal of this study was to explore the possibility of using respiratory inductive plethysmography (RIP) to serve as an objective measure of change in respiratory function in infants with VB receiving albuterol (ALB) therapy. This was a randomized, double-blind, placebo-controlled study in previously healthy infants hospitalized for VB. Study subjects randomly received either ALB (0.1 mg/kg) or normal saline (NS) by nebulization. RIP data were collected during clinically determined quiet sleep before and after treatment. We enrolled a total of 20 study subjects; 10 received ALB and 10 received NS. Mean tidal breathing measures did not change significantly in either group post-treatment. However, the phase angle fell by > 40% of baseline in 3 ALBtreated subjects (30%) and 4 NS (40%)-treated subjects. Using RIP, we observed improvements in the respiratory function in a subset of infants treated with ALB and with NS. It is possible that NS itself has beneficial effects. Our results suggest that RIP can serve as an objective measure of respiratory function in studies of infant VB.

Maybe there is no such thing as bronchiolitis

“…21,22 It is therefore not surprising that inhalation of normal saline appears to be beneficial in bronchiolitis. 13,20,22,23 Thus, the past unintentional use of an active therapeutic agent as placebo calls into question current conclusions that bronchodilators are not helpful in wheezing infants. Clinicians seem to share this skepticism, and most 24 continue to use bronchodilators (almost universally nebulized with normal saline) in bronchiolitis despite almost a decade of the AAP recommending that bronchodilators be used only if the infant shows a substantial clinical benefit from a trial dose.…”

Sex and the lung: Observations, hypotheses, and future directions

“…For example, if males have increased airway tone and cough, perhaps an anti‐cholinergic medication would be more efficacious than a beta agonist. This could be studied by using pulmonary function tests not requiring sedation such as tidal volume measurements and thoracoabdominal asynchrony using respiratory inductive plethysmography.…”

“…For example, if males have increased airway tone and cough, perhaps an anti-cholinergic medication would be more efficacious than a beta agonist. This could be studied by using pulmonary function tests not requiring sedation such as tidal volume measurements 78,79 and thoracoabdominal asynchrony 80 using respiratory inductive plethysmography. There are potential clinical benefits which could be derived from an increased understanding of how sex influences how the lung grows, develops, functions, and responds to treatment.…”

A systematic review of the psychometric properties of bronchiolitis assessment tools

“…The feasibility of developing a validated, reliable scoring system that is sensitive to important clinical changes is questioned and it is suggested that quantitative measures, such as respiratory inductive plethysmography, may provide a more objective measure of treatment response (Scarlett et al . ).…”