The efficacy of
albuterol in the management of infants with first-time
wheezing is controversial. This double-blind, placebo-controlled trial involved 128 Egyptian infants with first-time
wheezing (mean age 5.9 months) who were randomly separated into four equivalent
therapy groups: nebulized
albuterol, nebulized
saline solution, orally administered
albuterol, and orally administered placebo. The nebulized
therapy groups received two treatments 30 minutes apart; the oral
therapy groups received one treatment. In addition, 41 infants with recurrent
wheezing comprised an open-label control group who received two
albuterol nebulizations. Chest radiographs, leukocyte counts, blood culture specimens, and nasal aspirate for
viral antigen detection were obtained to confirm the clinical diagnosis of
viral bronchiolitis. Respiratory and heart rates, clinical score, and oxygen saturation were recorded at baseline 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 group compared with a decrease in heart rate of 8 beats/min in the oral placebo group. No differences in the need for additional treatment were observed. Nebulized
albuterol significantly improved the clinical score and reduced the respiratory rate of those with recurrent
wheezing relative to those in the randomized groups. We conclude that nebulized
albuterol is effective in the treatment of infants with recurrent
wheezing, but there was no demonstrable efficacy of orally administered or nebulized
albuterol in relieving the respiratory distress of infants with
bronchiolitis in Egypt.