ORAL VERSUS NEBULIZED ALBUTEROL IN THE MANAGEMENT OF BRONCHIOLITIS INEGYPT

The efficacy of albuterol in the management of infants with first-time wheezing is controversial. This double-blind, placebo-controlled tria l involved 128 Egyptian infants with first-time wheezing (mean age 5.9 months) who were randomly separated into four equivalent therapy grou ps: nebulized albuterol, nebulized saline solution, orally administere d albuterol, and orally administered placebo. The nebulized therapy gr oups received two treatments 30 minutes apart; the oral therapy groups received one treatment. In addition, 41 infants with recurrent wheezi ng comprised an open-label control group who received two albuterol ne bulizations: Chest radiographs, leukocyte counts, blood culture specim ens, and nasal aspirate for viral antigen detection were obtained to c onfirm the clinical diagnosis of viral bronchiolitis. Respiratory and heart rates, clinical score, and oxygen saturation were recorded at ba seline and 30 and 60 minutes after treatment. There was no difference among the four randomized groups in any of the outcomes except for an increase in heart rate of 10 beats/min in the nebulized albuterol grou p compared with a decrease in heart rate of 8 beats/min in the oral pl acebo group. No differences in the need for additional treatment were observed. Nebulized albuterol significantly improved the clinical scor e and reduced the respiratory rate of those with recurrent wheezing re lative to those in the randomized groups. We conclude that nebulized a lbuterol is effective in the treatment of infants with recurrent wheez ing, but there was no demonstrable efficacy of orally administered or nebulized albuterol in relieving the respiratory distress of infants w ith bronchiolitis in Egypt.