Clinical outcomes of bronchodilator use in bronchiolitis: an evidence-based perspective

Bronchiolitis is a leading cause of lower respiratory tract infection in infants, most commonly associated with respiratory syncytial virus, and contributes significantly to global pediatric morbidity. Despite its high prevalence, management remains largely supportive, as no pharmacologic therapy has consistently demonstrated a reduction in disease duration or hospitalization outcomes. This review evaluates the clinical efficacy of bronchodilators, particularly salbutamol, in the treatment of bronchiolitis based on current evidence. While some randomized controlled trials report short-term improvements in clinical scores following bronchodilator administration, pooled data from meta-analyses indicate no significant benefit in key clinical outcomes, including oxygen saturation, hospitalization rates, length of hospital stay, or time to resolution of illness. Furthermore, bronchodilator use has been associated with adverse physiological effects, such as increased heart rate and respiratory rate. The underlying pathophysiology of bronchiolitis, characterized primarily by airway obstruction due to inflammation, edema, and mucus plugging rather than bronchospasm, explains the limited efficacy of bronchodilators. Current international guidelines strongly discourage their routine use and emphasize supportive care as the cornerstone of management. Bridging the gap between evidence and clinical practice is essential to avoid unnecessary interventions and optimize patient outcomes.