A 6-week-old infant presents in winter with 3 days of rhinorrhea followed by wheeze, subcostal recessions, and an O2 saturation of 91%. Chest X-ray shows hyperinflation. Nasopharyngeal swab RSV antigen is positive. What is the role of inhaled salbutamol in this infant?
- A Salbutamol has no proven benefit in typical RSV bronchiolitis; management is supportive ✓
- B Salbutamol is the primary treatment and should be given every 4 hours
- C Salbutamol combined with ipratropium should be given via nebulization
- D Salbutamol is contraindicated; use IV epinephrine instead
Explanation
Bronchiolitis in infants is a disease of lower airway inflammation, mucosal edema, and mucus plugging — not primarily bronchoconstriction. Multiple RCTs and systematic reviews (including the AAP 2014 bronchiolitis guideline, updated 2023) confirm that bronchodilators (salbutamol, albuterol, epinephrine) do not improve outcomes in typical viral bronchiolitis and are not recommended as routine treatment. Management is supportive: oxygen for hypoxia, nasogastric/IV fluids for inadequate oral intake, and careful monitoring. Nebulized hypertonic saline (3%) may modestly reduce length of hospital stay.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.