INTRODUCCIÓN
La bronquiolitis es la inflamación aguda de las vías aéreas de pequeño calibre, teniendo como causa principal las infecciones virales. Es altamente frecuente en menores de dos años, sobretodo en menores de 12 meses. Existe gran controversia sobre el manejo de esta patología, siendo especialmente cuestionable el uso de beta-2 agonistas de corta acción tanto en el ámbito ambulatorio como hospitalario.

MÉTODOS
Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis, y preparamos una tabla de resumen de los resultados utilizando el método GRADE.

RESULTADOS Y CONCLUSIONES
Identificamos siete revisiones sistemáticas que en conjunto incluyen 49 estudios primarios, de los cuales, 44 corresponden a ensayos aleatorizados. Concluimos que el uso de beta-2 agonistas podría no tener ningún beneficio en el manejo de la bronquiolitis, en términos de necesidad de hospitalización y/o duración de la misma. Por otra parte, podría aumentar efectos adversos como arritmias, sin embargo, la certeza de esta evidencia es baja.

Authors: Constanza Gómez[1,2], Gonzalo Alarcón[1,2], Lorena Cifuentes[1,2]

Affiliation:
[1] Departamento de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
[2] Proyecto Epistemonikos, Santiago, Chile

E-mail: lorena.cifuentes@uc.cl

Author address:
[1] Centro Evidencia UC
Pontificia Universidad Católica de Chile
Diagonal Paraguay 476
Santiago
Chile

Citation: Gómez C, Alarcón G, Cifuentes L. Beta-2 agonists for the treatment of bronchiolitis. Medwave 2020;20(08):e7947 doi: 10.5867/medwave.2020.08.7947

Submission date: 24/12/2018

Acceptance date: 28/12/2018

Publication date: 3/9/2020

Origin: This article is a product of the Evidence Synthesis Project of Epistemonikos Fundation, in collaboration with Medwave for its publication.

Type of review: Not non-blind peers by the UC Evidence Center methodological team in collaboration with Epistemonikos Evidence Synthesis Project.

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2. Flores G, Horwitz RI. Efficacy of beta2-agonists in bronchiolitis: a reappraisal and meta-analysis. Pediatrics. 1997 Aug;100(2 Pt 1):233-9. | CrossRef | PubMed |
3. Fily A. [Role of bronchodilators in the treatment of acute infant bronchiolitis]. Arch Pediatr. 2001 Jan;8 Suppl 1:149S-156S. Review. French. | PubMed |
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5. Hartling L, Fernandes RM, Bialy L, Milne A, Johnson D, Plint A, Klassen TP, Vandermeer B. Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis. BMJ. 2011 Apr 6;342:d1714. doi: 10.1136/bmj.d1714. Review. | CrossRef | PubMed | PMC |
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7. Guo C, Sun X, Wang X, Guo Q, Chen D. Network Meta-Analysis Comparing the Efficacy of Therapeutic Treatments for Bronchiolitis in Children. JPEN J Parenter Enteral Nutr. 2018 Jan;42(1):186-195. doi: 10.1002/jpen.1030. Epub 2017 Nov 3. | CrossRef | PubMed |
8. Abu-Shukair M, El-Tal Y, Al-Rawabdeh E. Salbutamol versus epinephrine in the treatment of acute bronchiolitis. Journal of the Bahrain Medical Society 2001;13(3):143–6.
9. Alario AJ, Lewander WJ, Dennehy P, Seifer R, Mansell AL. The efficacy of nebulized metaproterenol in wheezing infants and young children. Am J Dis Child. 1992 Apr;146(4):412-8. | PubMed |
10. Anil AB, Anil M, Saglam AB, Cetin N, Bal A, Aksu N. High volume normal saline alone is as effective as nebulized salbutamol-normal saline, epinephrine-normal saline, and 3% saline in mild bronchiolitis. Pediatr Pulmonol. 2010 Jan;45(1):41-7. | CrossRef | PubMed |
11. Barlas, C, Kiper, N, Gocmen, A, Ozcelik, U, Dilber, E, Anadol, D. [Racemic adrenaline and other treatment regimens in mild and moderate bronchiolitis]. Çocuk Sağlığı ve Hastalıkları Dergisi (Turkish Pediatric Journal). 1998;41(2):155-65.
12. Beck R, Elias N, Shoval S, Tov N, Talmon G, Godfrey S, Bentur L. Computerized acoustic assessment of treatment efficacy of nebulized epinephrine and albuterol in RSV bronchiolitis. BMC Pediatr. 2007 Jun 2;7:22. | CrossRef | PubMed | PMC |
13. Bertrand P, Araníbar H, Castro E, Sánchez I. Efficacy of nebulized epinephrine versus salbutamol in hospitalized infants with bronchiolitis. Pediatr Pulmonol. 2001 Apr;31(4):284-8. | CrossRef | PubMed |
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17. Chevallier B, Aegerter P, Parat S, Bidat E, Renaud C, Lagardère B. [Comparative study of nebulized sambutol against placebo in the acute phase of bronchiolitis in 33 infants aged 1 to 6 months]. Arch Pediatr. 1995 Jan;2(1):11-7. French. | CrossRef | PubMed |
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19. Dobson JV, Stephens-Groff SM, McMahon SR, Stemmler MM, Brallier SL, Bay C. The use of albuterol in hospitalized infants with bronchiolitis. Pediatrics. 1998 Mar;101(3 Pt 1):361-8. | PubMed |
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22. Goh A, Chay OM, Foo AL, Ong EK. Efficacy of bronchodilators in the treatment of bronchiolitis. Singapore Med J. 1997 Aug;38(8):326-8. | PubMed |
23. Gómez-y-López RE, Hernández-Sierra JF, Torres-Ruvalcaba BA, Martínez-Puente E, del Carmen Martínez-Garcia M. [Comparative clinical study of dexamethasone vs. nebulized salbutamol in acute bronchiolitis]. Gac Med Mex. 2007 May-Jun;143(3):189-92. Spanish. | PubMed |
24. Gupta P, Aggarwal A, Gupta P, Sharma KK. Oral salbutamol for symptomatic relief in mild bronchiolitis a double blind randomized placebo controlled trial. Indian Pediatr. 2008 Jul;45(7):547-53. | PubMed |
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26. Ho L, Collis G, Landau LI, Le Souef PN. Effect of salbutamol on oxygen saturation in bronchiolitis. Arch Dis Child. 1991 Sep;66(9):1061-4. | PubMed | PMC |
27. Ipek IO, Yalcin EU, Sezer RG, Bozaykut A. The efficacy of nebulized salbutamol, hypertonic saline and salbutamol/hypertonic saline combination in moderate bronchiolitis. Pulm Pharmacol Ther. 2011 Dec;24(6):633-7. | CrossRef | PubMed |
28. John, BM, Patnaik, SK, Prasad, PL. Efficacy of nebulised epinephrine versus salbutamol in hospitalised children with bronchiolitis. Medical Journal Armed Forces India. 2006;62(4):354-357. | CrossRef |
29. Karadag, B, Ceran, O, Dursun, E, Guven, G, Ozahi, I, Karakoc, F. Efficacy of bronchodilators in acute bronchiolitis. European Respiratory Journal. 2000;16(Suppl 31):562.
30. Karadag, B, Cerna, O, Dursun, E, Guven, G, Ozahi, I, Karakoc, F. Comparison of bronchodilators in acute bronchiolitis. European Respiratory Society Annual Congress. 2002;
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32. Khashabi, J., Lak, S. Salari, Karamiyar, M., Mussavi, H.. Comparison of the efficacy of nebulized L-epinephrine, salbutamol and normal saline in acute bronchiolitis: a randomized clinical trial. Medical Journal of The Islamic Republic of Iran. 2005;19(2):119-25.
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35. Levin DL, Garg A, Hall LJ, Slogic S, Jarvis JD, Leiter JC. A prospective randomized controlled blinded study of three bronchodilators in infants with respiratory syncytial virus bronchiolitis on mechanical ventilation. Pediatr Crit Care Med. 2008 Nov;9(6):598-604. | CrossRef | PubMed |
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Kellner JD, Ohlsson A, Gadomski AM, Wang EE. Efficacy of bronchodilator therapy in bronchiolitis. A meta-analysis. Arch Pediatr Adolesc Med. 1996 Nov;150(11):1166-72. | CrossRef | PubMed |

Flores G, Horwitz RI. Efficacy of beta2-agonists in bronchiolitis: a reappraisal and meta-analysis. Pediatrics. 1997 Aug;100(2 Pt 1):233-9. | CrossRef | PubMed |

Fily A. [Role of bronchodilators in the treatment of acute infant bronchiolitis]. Arch Pediatr. 2001 Jan;8 Suppl 1:149S-156S. Review. French. | PubMed |

King VJ, Viswanathan M, Bordley WC, Jackman AM, Sutton SF, Lohr KN, Carey TS. Pharmacologic treatment of bronchiolitis in infants and children: a systematic review. Arch Pediatr Adolesc Med. 2004 Feb;158(2):127-37. Review. | CrossRef | PubMed |

Hartling L, Fernandes RM, Bialy L, Milne A, Johnson D, Plint A, Klassen TP, Vandermeer B. Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis. BMJ. 2011 Apr 6;342:d1714. doi: 10.1136/bmj.d1714. Review. | CrossRef | PubMed | PMC |

Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2014 Jun 17;(6):CD001266. doi: 10.1002/14651858.CD001266.pub4. Review. | CrossRef | PubMed |

Guo C, Sun X, Wang X, Guo Q, Chen D. Network Meta-Analysis Comparing the Efficacy of Therapeutic Treatments for Bronchiolitis in Children. JPEN J Parenter Enteral Nutr. 2018 Jan;42(1):186-195. doi: 10.1002/jpen.1030. Epub 2017 Nov 3. | CrossRef | PubMed |

Abu-Shukair M, El-Tal Y, Al-Rawabdeh E. Salbutamol versus epinephrine in the treatment of acute bronchiolitis. Journal of the Bahrain Medical Society 2001;13(3):143–6.

Alario AJ, Lewander WJ, Dennehy P, Seifer R, Mansell AL. The efficacy of nebulized metaproterenol in wheezing infants and young children. Am J Dis Child. 1992 Apr;146(4):412-8. | PubMed |

Anil AB, Anil M, Saglam AB, Cetin N, Bal A, Aksu N. High volume normal saline alone is as effective as nebulized salbutamol-normal saline, epinephrine-normal saline, and 3% saline in mild bronchiolitis. Pediatr Pulmonol. 2010 Jan;45(1):41-7. | CrossRef | PubMed |

Barlas, C, Kiper, N, Gocmen, A, Ozcelik, U, Dilber, E, Anadol, D. [Racemic adrenaline and other treatment regimens in mild and moderate bronchiolitis]. Çocuk Sağlığı ve Hastalıkları Dergisi (Turkish Pediatric Journal). 1998;41(2):155-65.

Beck R, Elias N, Shoval S, Tov N, Talmon G, Godfrey S, Bentur L. Computerized acoustic assessment of treatment efficacy of nebulized epinephrine and albuterol in RSV bronchiolitis. BMC Pediatr. 2007 Jun 2;7:22. | CrossRef | PubMed | PMC |

Bertrand P, Araníbar H, Castro E, Sánchez I. Efficacy of nebulized epinephrine versus salbutamol in hospitalized infants with bronchiolitis. Pediatr Pulmonol. 2001 Apr;31(4):284-8. | CrossRef | PubMed |

Bilan, N, Seyyed Sadri, N. Clinical efficacy of salbutamol spray in treatment of bronchiolitis. Medical Journal of Tabriz University of Medical Sciences. 2007;29(1):27-29.

Can D, Inan G, Yendur G, Oral R, Günay I. Salbutamol or mist in acute bronchiolitis. Acta Paediatr Jpn. 1998 Jun;40(3):252-5. | CrossRef | PubMed |

Cengizlier R, Saraçlar Y, Adalioğlu G, Tuncer A. Effect of oral and inhaled salbutamol in infants with bronchiolitis. Acta Paediatr Jpn. 1997 Feb;39(1):61-3. | CrossRef | PubMed |

Chevallier B, Aegerter P, Parat S, Bidat E, Renaud C, Lagardère B. [Comparative study of nebulized sambutol against placebo in the acute phase of bronchiolitis in 33 infants aged 1 to 6 months]. Arch Pediatr. 1995 Jan;2(1):11-7. French. | CrossRef | PubMed |

Chowdhury D, al Howasi M, Khalil M, al-Frayh AS, Chowdhury S, Ramia S. The role of bronchodilators in the management of bronchiolitis: a clinical trial. Ann Trop Paediatr. 1995;15(1):77-84. | CrossRef | PubMed |

Dobson JV, Stephens-Groff SM, McMahon SR, Stemmler MM, Brallier SL, Bay C. The use of albuterol in hospitalized infants with bronchiolitis. Pediatrics. 1998 Mar;101(3 Pt 1):361-8. | PubMed |

Gadomski AM, Lichenstein R, Horton L, King J, Keane V, Permutt T. Efficacy of albuterol in the management of bronchiolitis. Pediatrics. 1994 Jun;93(6 Pt 1):907-12. | PubMed |

Gadomski AM, Aref GH, el Din OB, el Sawy IH, Khallaf N, Black RE. Oral versus nebulized albuterol in the management of bronchiolitis in Egypt. J Pediatr. 1994 Jan;124(1):131-8. | CrossRef | PubMed |

Goh A, Chay OM, Foo AL, Ong EK. Efficacy of bronchodilators in the treatment of bronchiolitis. Singapore Med J. 1997 Aug;38(8):326-8. | PubMed |

Gómez-y-López RE, Hernández-Sierra JF, Torres-Ruvalcaba BA, Martínez-Puente E, del Carmen Martínez-Garcia M. [Comparative clinical study of dexamethasone vs. nebulized salbutamol in acute bronchiolitis]. Gac Med Mex. 2007 May-Jun;143(3):189-92. Spanish. | PubMed |

Gupta P, Aggarwal A, Gupta P, Sharma KK. Oral salbutamol for symptomatic relief in mild bronchiolitis a double blind randomized placebo controlled trial. Indian Pediatr. 2008 Jul;45(7):547-53. | PubMed |

Gurkan, F, Tuzun, H, Ece, A, Haspolat, K, Bosnak, M, Dikici, B. Comparison of treatments with nebulized salbutamol and epinephrine in acute bronchiolitis. 14th ERS Annual Congress; Glasgow, UK (Published in: European Respiratory Journal 2004;24(Suppl 48):344). 2004;24(Suppl 48):344.

Ho L, Collis G, Landau LI, Le Souef PN. Effect of salbutamol on oxygen saturation in bronchiolitis. Arch Dis Child. 1991 Sep;66(9):1061-4. | PubMed | PMC |

Ipek IO, Yalcin EU, Sezer RG, Bozaykut A. The efficacy of nebulized salbutamol, hypertonic saline and salbutamol/hypertonic saline combination in moderate bronchiolitis. Pulm Pharmacol Ther. 2011 Dec;24(6):633-7. | CrossRef | PubMed |

John, BM, Patnaik, SK, Prasad, PL. Efficacy of nebulised epinephrine versus salbutamol in hospitalised children with bronchiolitis. Medical Journal Armed Forces India. 2006;62(4):354-357. | CrossRef |

Karadag, B, Ceran, O, Dursun, E, Guven, G, Ozahi, I, Karakoc, F. Efficacy of bronchodilators in acute bronchiolitis. European Respiratory Journal. 2000;16(Suppl 31):562.

Karadag, B, Cerna, O, Dursun, E, Guven, G, Ozahi, I, Karakoc, F. Comparison of bronchodilators in acute bronchiolitis. European Respiratory Society Annual Congress. 2002;

Karadag B, Ceran O, Guven G, Dursun E, Ipek IO, Karakoc F, Ersu RH, Bozaykut A, Inan S, Dagli E. Efficacy of salbutamol and ipratropium bromide in the management of acute bronchiolitis--a clinical trial. Respiration. 2008;76(3):283-7. Epub 2007 Nov 28. | CrossRef | PubMed |

Khashabi, J., Lak, S. Salari, Karamiyar, M., Mussavi, H.. Comparison of the efficacy of nebulized L-epinephrine, salbutamol and normal saline in acute bronchiolitis: a randomized clinical trial. Medical Journal of The Islamic Republic of Iran. 2005;19(2):119-25.

Klassen TP, Rowe PC, Sutcliffe T, Ropp LJ, McDowell IW, Li MM. Randomized trial of salbutamol in acute bronchiolitis. J Pediatr. 1991 May;118(5):807-11. Erratum in: J Pediatr 1991 Dec;119(6):1010. | CrossRef | PubMed |

Kuyucu S, Unal S, Kuyucu N, Yilgor E. Additive effects of dexamethasone in nebulized salbutamol or L-epinephrine treated infants with acute bronchiolitis. Pediatr Int. 2004 Oct;46(5):539-44. | CrossRef | PubMed |

Levin DL, Garg A, Hall LJ, Slogic S, Jarvis JD, Leiter JC. A prospective randomized controlled blinded study of three bronchodilators in infants with respiratory syncytial virus bronchiolitis on mechanical ventilation. Pediatr Crit Care Med. 2008 Nov;9(6):598-604. | CrossRef | PubMed |

Lines, DR, Kattampallil, JS, Liston, P. Efficacy of nebulized salbutamol in bronchiolitis. Pediatric Reviews & Communications. 1990;5:121-9.

Luo Z, Liu E, Luo J, Li S, Zeng F, Yang X, Fu Z. Nebulized hypertonic saline/salbutamol solution treatment in hospitalized children with mild to moderate bronchiolitis. Pediatr Int. 2010 Apr;52(2):199-202. DOI: 10.1111/j.1442-200X.2009.02941.x. Epub 2009 Aug 7. | PubMed |

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