Keywords
Bronchiolitis
Deprescriptions
Health Evaluation
How to Cite
Abstract
Introduction: the use of salbutamol in bronchiolitis remains widespread despite limited evidence of clinical benefit, with ongoing uncertainties regarding its effectiveness and utilization patterns in our country.
Objectives: assess the use of salbutamol in bronchiolitis, its association with clinical response, patient outcomes, and associated healthcare costs.
Methodology: a retrospective observational study of patients hospitalized for bronchiolitis was conducted. Salbutamol use, clinical response, intensive care unit (ICU) admission, respiratory support, length of hospital stay, and mortality were analyzed. Descriptive analyses and multivariable models adjusted for baseline severity, age, and comorbidities were performed. Cost impact was also estimated.
Results: a total of 698 patients were included, of whom 600 (85,9%) received salbutamol. The clinical response rate was low, and immediate clinical deterioration was observed in a relevant proportion of patients. The clinical response rate was 6.8%; the proportion experiencing immediate post-administration deterioration was 22.7%; and the incremental cost was $U 31.2 million compared to the untreated group. Salbutamoluse was more frequent in patients presenting with higher baseline severity. In adjusted analyses, disease severity was associated with a higher likelihood of clinical response, without consistent associations for other variables. Salbutamol use was associated with higher ICU admission rates, longer length of stay, and increased resource utilization, particularly among non-responders or those experiencing clinical deterioration.
Conclusions: salbutamol utilization in bronchiolitis was high and was associated with a low rate of clinical response and increased resource utilization. These findings underscore the need to avoid routine salbutamol administration and to implement deprescribing strategies, alongside improving guideline adherence and optimizing clinical practice.
References
1. Assandri E, Casuriaga A, Le Pera V, Notejane M, Vázquez M, Zunino C. Atención pediátrica: normas nacionales de diagnóstico, tratamiento y prevención. 9 ed. Montevideo: Oficina del Libro – FEFMUR, 2020.
2. Pinchak C, Vomero A, Pérez W. Guía de diagnóstico y tratamiento de bronquiolitis: evidencias y recomendaciones. Montevideo: CHPR, SUP, 2017.
3. Asociación Española De Pediatría, Sociedad Española de Neumología Pediátrica. Protocolos diagnósticos y terapéuticos en neumología pediátrica. 2 ed. Madrid: AEP, SENP, 2017. Disponible en: https://www.aeped.es/sites/default/files/documentos/protocolos_diagn_y_terap_neumoped_aep.pdf.(Consulta: 11 julio 2023).
4. Asociación Española de Pediatría. Comité de Medicamentos. Salbutamol: Fecha de actualización: Noviembre 2020. Disponible en: https://www.aeped.es/comite-medicamentos/pediamecum/salbutamol. (Consulta: 11 julio 2023).
5. Cai Z, Lin Y, Liang J. Efficacy of salbutamol in the treatment of infants with bronchiolitis: A meta-analysis of 13 studies. Medicine (Baltimore) 2020; 99(4):e18657. doi: 10.1097/MD.0000000000018657.
6. Flores G, Horwitz R. Efficacy of beta2-agonists in bronchiolitis: a reappraisal and meta-analysis. Pediatrics 1997; 100(2 Pt 1):233-9. doi: 10.1542/peds.100.2.233.
7. Friedman J, Rieder M, Walton J. Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age. Paediatr Child Health 2014; 19(9):485-98. doi: 10.1093/pch/19.9.485.
8. Gadomski A, Scribani M. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev 2014; 2014(6):CD001266. doi: 10.1002/14651858.CD001266.pub4.
9. Ralston S, Lieberthal A, Meissner H, Alverson B, Baley J, Gadomski A, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014; 134(5):e1474-502. doi: 10.1542/peds.2014-2742.
10. Benito J, Paniagua N. Diagnóstico y tratamiento de la bronquiolitis aguda en Urgencias. Protoc Diagn Ter Pediatr 2020; 1:63-73. Disponible en: https://www.samfyc.es/wp-content/uploads/2022/11/20_bronquiolitis.pdf. (Consulta: 11 julio 2023).
11. National Institute for Health and Care excellence. NICE guideline No. 9. Bronchiolitis in children: diagnosis and management. London: NICE, 2021. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK573086/. (Consulta: 11 julio 2023).
12. Benito J, Paniagua N. Diagnóstico y tratamiento de la bronquiolitis aguda en Urgencias. En: Sociedad Española de Urgencias de Pediatría. Protocolos diagnósticos y terapéuticos en urgencias de pediatría. 4 ed. Madrid: SEUP, 2024. Disponible en: https://seup.org/wp-content/uploads/2024/04/5_Bronquiolitis_4ed.pdf. (Consulta: 11 julio 2024).
13. Iriondo M, Claret G, Simó M, Jordán I, Pons M. Bronquiolitis aguda. En: Cubells C. Urgencias en pediatría: protocolos diagnóstico-terapéuticos Hospital Sant Joan de Déu Barcelona. 6 ed. Madrid: Ergon, 2022:112-20.
14. Martínez L, Díaz F, González S, Monteverde N, Serra A, Pedrozo L, et al. Admisiones por bronquiolitis en 13 unidades de cuidados intensivos pediátricos del Uruguay: ¿es igual en Montevideo que en el interior? Rev Méd Urug 2021; 37(2):e206. doi: 10.29193/rmu.37.2.6.
15. Noli P, Geymonat M, Bustelo E, Muñoz J, Saibene S, Dall’Orso P, et al. Infecciones respiratorias agudas bajas de causa viral en niños hospitalizados en el Centro Hospitalario Pereira Rossell: características clínicas y terapéuticas. Arch Pediatr Urug 2012; 83(4):250-6. Disponible en: http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-12492012000400002.(Consulta: 11 julio 2023).
16. Oakley E, Brys T, Borland M, Neutze J, Phillips N, Krieser D, et al. Medication use in infants admitted with bronchiolitis. Emerg Med Australas 2018; 30(3):389-97. doi: 10.1111/1742-6723.12968.
17. Giachetto G, Cruz L, Harretche A, Ferreira A. Impacto de la estrategia Plan de Invierno en el uso de medicamentos en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell CHPR). Rev Méd Urug 2022; 18(2):148-53. Disponible en: http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-03902002000200005. (Consulta: 11 julio 2023).
18. Cano A, Praena M, Mora I, Carvajal I, Callén M, García Á Heterogeneidad de criterios en el diagnóstico de bronquiolitis aguda en España. An Pediatr (Barc) 2019; 90(2):109-7. Doi: 10.1016/j.anpedi.2018.07.004.
19. Hancock D, Charles B, Dixon D, Forsyth K. The heterogeneity of viral bronchiolitis: A lack of universal consensus definitions. Pediatr Pulmonol 2017; 52(9):1234-40. doi: 10.1002/ppul.23750.
20. Universidad de la República, Facultad de Medicina, Departamento de Pediatría. Administración de Servicios de Salud del Estado, Centro Hospitalario Pereira Rossell, Hospital Pediátrico. Manual Plan Invierno 2023. Montevideo: CHPR, 2023.
21. Cruces P. El lado B del uso de beta-agonistas en niños con falla respiratoria aguda. Rev Chil Pediatr 2015; 86(2):71-2. doi: 10.1016/j.rchipe.2015.05.004.
22. Gadomski A, Scribani M. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev 2014; 2014(6):CD001266. doi: 10.1002/14651858.CD001266.pub4.
23. Serra J, González S, Vásquez P, Carvajal C, Donoso A, Cruces P, et al. Variabilidad terapéutica en lactantes con bronquiolitis hospitalizados en unidades de cuidados intensivos latinoamaericanas. Rev Chil Pediatr 2020; 91(2):216-25. doi: 10.32641/rchped.v91i2.1156.
24. Rivera A, Rebmann T, Gerard J, Charney R. Physician compliance with bronchiolitis guidelines in pediatric emergency departments. Clin Pediatr (Phila) 2019; 58(9):1008-18. doi: 10.1177/0009922819850462.
25. Condella A, Mansbach J, Hasegawa K, Dayan P, Sullivan A, Espinola J, et al. Multicenter study of albuterol use among infants hospitalized with bronchiolitis. West J Emerg Med 2018; 19(3):475-83. doi: 10.5811/westjem.2018.3.35837.
26. Schramm C, Sala K, Carroll C. Clinical examination does not predict response to albuterol in ventilated infants with bronchiolitis. Pediatr Crit Care Med 2017; 18(1):e18-e23. doi: 10.1097/PCC.0000000000000999.
27. Del Vecchio M, Doerr L, Gaughan J. The Use of Albuterol in Young Infants Hospitalized with Acute RSV Bronchiolitis. Interdiscip Perspect Infect Dis 2012; 2012:585901. doi: 10.1155/2012/585901.
28. Poço S, Rodrigues H, Oliveira S. Acute bronchiolitis: the economic impact of non-compliance with national guidelines. J Healthc Qual Res 2024; 39(5):299-305. doi: 10.1016/j.jhqr.2024.06.005.
29. Giachetto G, Vomero A, Pandolfo S, Notejane M, García L, Cavallieri F, et al. Validación del score clínico de Tal modificado para la evaluación de severidad en bronquiolitis. Arch Pediatr Urug 2018; 89(Supl 1):S43-8. Doi: 10.31134/ap.89.s1.5.
30. Granda E, Urbano M, Andrés P, Corchete M, Cano A, Velasco R. Comparison of severity scales for acute bronchiolitis in real clinical practice. Eur J Pediatr 2023; 182(4):1619-26. doi: 10.1007/s00431-023-04840-5.
31. Dunn M, Muthu N, Burlingame C, Gahman A, McCloskey M, Tyler L, et al. Reducing albuterol use in children with bronchiolitis. Pediatrics 2020; 145(1):e20190306. doi: 10.1542/peds.2019-0306.
32. Andina D, Escalada S, Viaño P, Alonso J, Martín M, de la Torre M,et al. Descenso del uso de broncodilatadores en el manejo de la bronquiolitis tras aplicar iniciativas de mejora. An Pediatr 2022; 96(6):476-84. doi: 10.1016/j.anpedi.2021.05.001.
33. Arrotcharen S. Conjunto de datos de: Uso de Salbutamol en Bronquiolitis en un Centro Hospitalario (Internet). Montevideo: redata; 2026 ene 22 Disponible en: https://doi.org/10.60895/redata/CABZWC.
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Copyright (c) 2026 Santiago Arrotcharen, Blauco Rodriguez Andrada, Dinorah Bidegain, Alberto Barrios, Lucas Carbajal, Gabriela Parallada, Laura Rodriguez, Helios Chernic