Efficacy of Bronchodilator Therapy in Bronchiolitis: A Meta-analysis

doi:10.1001/archpedi.1996.02170360056009

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Vol. 150 No. 11, November 1996

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Efficacy of Bronchodilator Therapy in Bronchiolitis

A Meta-analysis

James D. Kellner, MD, FRCPC; Arne Ohlsson, MD, MSc, FRCPC; Anne M. Gadomski, MD, MPH, FAAP; Elaine E. L. Wang, MDCM, MSc, FRCPC

Arch Pediatr Adolesc Med. 1996;150(11):1166-1172.

Abstract

Objective
To determine if bronchodilators are efficacious in treatingbronchiolitis.

Data Sources
A search of bibliographic databases (MEDLINE, Excerpta Medica,and Reference Update) for bronchiolitis and albuterol or ipratropiumbromide, or adrenergic agents or bronchodilator agents. Referencelists were also used.

Study Selection
Randomized, placebo-controlled trials of bronchodilator treatmentin bronchiolitis were selected by 2 investigators. Fifteen of89 identified publications met the selection criteria.

Data Extraction
Investigators independently abstracted data for 3 outcomes:clinical score, oxygen saturation, and hospitalization. Clinicalscore was measured as a dichotomous variable (score±improved)or continuous variable (average score).

Data Synthesis
For primary analysis, data were pooled from 8 trials of childrenwith first-time wheezing. The effect size for average scorewas –0.32 (95% confidence interval [CI], –0.54 to–0.11; P<.01), favoring treatment; the relative riskfor score±improved was 0.76 (95% CI, 0.60 to 0.95; P=.02),favoring treatment. Bronchodilators had no effect on hospitalization(relative risk, 0.85; 95% CI, 0.47 to 1.53; P=.58), but co-interventionsmay have been administered prior to this outcome. The resultsfor oxygen saturation were too varied to allow pooling of theresults. Secondary analyses were performed on 4 outpatient trialsof children with first-time wheezing, 7 trials in which onlynebulized β-agonists were used, and on all 15 trials identified.The results were similar, but the data varied more.

Conclusion
Bronchodilators produce modest shortterm improvement in clinicalfeatures of mild or moderately severe bronchiolitis.

Arch Pediatr Adolesc Med. 1996;150:1166-1172

Author Affiliations

From the Division of Infectious Diseases and Clinical Epidemiology Unit, The Hospital for Sick Children (Drs Kellner and Wang), Department of Paediatrics and Clinical Epidemiology and Health Care Research Program, University of Toronto (Drs Kellner, Ohlsson, and Wang), and Department of Newborn and Developmental Paediatrics and Perinatal Clinical Epidemiology Unit, Women's College Hospital (Dr Ohlsson), Toronto, Ontario; and Bassett Healthcare Research Institute and The Mary Imogene Bassett Hospital, Cooperstown, NY (Dr Gadomski).

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