For which infants with viral bronchiolitis could it be deemed appropriate to use albuterol, at least on a therapeutic trial basis?

Abstract

Although there is increasing evidence showing that infants with viral bronchiolitis exhibit ahigh degree of heterogeneity, a core uncertainty shared by many clinicians is with regard tounderstanding which patients are most likely to benefit from bronchodilators such as albuterol.Based on our review, we concluded that older infants with rhinovirus (RV) bronchiolitis, especiallythose with a nasopharyngeal microbiome dominated by Haemophilus influenzae; thoseaffected during nonpeak months or during non-respiratory syncytial virus (RSV) predominantmonths; those with wheezing at presentation; those with clinical characteristics such as atopicdermatitis or a family history of asthma in a first-degree relative; and those infants infectedwith RSV genotypes ON1 and BA, have the greatest likelihood of benefiting from albuterol.Presently, this patient profile could serve as the basis for rational albuterol administrationin patients with viral bronchiolitis, at least on a therapeutic trial basis, and it could also bethe starting point for future targeted randomized clinical trials (RCTs) on the use of albuterolamong a subset of infants with bronchiolitis