Delivery of salbutamol by metered dose inhaler and valved spacer to wheezy infants: effect on bronchial responsiveness. Airway responsiveness in wheezy infants: evidence for functional beta adrenergic receptors. Inhaled salbutamol for wheezy infants: a randomised controlled trial. Controlled trial of nebulized albuterol in children younger than 2 years of age with acute asthma. Clinical and physiological improvement after inhalation of low-dose beclomethasone dipropionate and salbutamol in wheezy infants. Treatment of recurrent acute wheezing episodes in infancy with oral salbutamol and prednisolone. Beta 2-agonists for the treatment of wheezy bronchitis?
The efficacy of a new valved spacer device, the Babyhaler inhaler (Glaxo) for administering metered dose inhaler treatment via a facemask to infants was assessed. In a double blind, single dose study, salbutamol (800 micrograms) or placebo were given on separate days to 12 sedated, sleeping, wheezy infants during a symptom free interval. Lung function was measured before and after administration and the bronchial response to aerosol challenge with methacholine was then assessed using the squeeze technique. A small increase in heart rate and a drop in arterial oxygen tension followed salbutamol administration. No other change in lung volume or air flow obstruction was detected. Bronchial responsiveness decreased significantly after the administration of salbutamol by Babyhaler, the PC30 (provoking concentration of methacholine causing a 30% fall in maximal flow at functional residual capacity by the squeeze technique) increasing from a median of 3.8 g/l after placebo to 12.5 g/l after salbutamol. The Babyhaler is an effective device for administering bronchodilator to wheezy infants. The small scale of the response may be attributable to the uncertain effect of beta agonists in this population. Furthermore, pulmonary deposition of inhaled aerosols may be reduced in nose breathing, sleeping infants. The effect of nebulised salbutamol on the bronchial response to nebulised histamine was studied in five wheezy infants aged 3-12 months. The response to doubling concentrations of up to 8 g/l of histamine was assessed by the change in the maximum flow at FRC (VmaxFRC), measured by flow-volume curves produced during forced expiration with a pressure jacket. The concentration of histamine required to provoke a 30% fall in VmaxFRC (PC30) was measured. All of the infants responded to low concentrations of histamine during control tests before and after nebulised saline (mean PC30 1.07 and 0.51 g/l). On a separate day there was a similar response to histamine before salbutamol (PC30 0.57 g/l), but after salbutamol the response was completely abolished up to the maximum concentration of histamine in all subjects (PC30 greater than 8 g/l). Thus wheezy infants have highly effective beta 2 adrenoceptors in intrathoracic airways. Salbutamol is frequently used as a bronchodilator for infants who wheeze. Many single dose studies have questioned its effectiveness.
                To investigate the response of wheezy infants to salbutamol over an extended time period in order to elucidate either symptomatic relief or a protective effect.
                Eighty infants under 1 year, with persistent or recurrent wheeze and a personal or family history of atopy, were recruited to a randomised, double blind, cross over, placebo controlled trial. Salbutamol (200 microg three times daily) or placebo were administered regularly over two consecutive treatment periods of four weeks via a spacer and mask. Symptoms of wheeze and cough were recorded in a diary. At the end of the study pulmonary function tests were performed before and after salbutamol (400 microg).
                Forty eight infants completed the diary study; 40 infants underwent pulmonary function testing. No difference in mean daily symptom score was observed between the salbutamol and placebo periods. There was no difference in the number of symptom free days. Compliance and forced expiratory flows remained unchanged and resistance increased following salbutamol. There was no relation between the response measured by symptom score or pulmonary function in individual patients.
                In wheezy infants with an atopic background, there was no significant beneficial effect of salbutamol on either clinical symptoms or pulmonary function. Clinical effects could not be predicted from pulmonary function tests. Salbutamol cannot be recommended as the bronchodilator of choice in this age group. To determine the response to nebulized beta 2 agonist, 28 children younger than 2 years of age who visited the emergency department during an episode of acute asthma were studied. Each subject had a previous history of recurrent wheezing episodes. They were randomly assigned to receive two administrations of either nebulized albuterol (0.15 mg/kg per dose) or placebo (normal saline) with oxygen, 1 hour apart. After two nebulizations, the albuterol-treated patients had a greater improvement in clinical status (respiratory rate, degree of wheezing and accessory muscle use, total clinical score, and arterial oxygen saturation) than the placebo group. None of the patients in the albuterol group experienced a decrease of arterial oxygen saturation of greater than or equal to 2%. It is concluded that a trial of nebulized beta 2 agonists is warranted in the treatment of acute asthma in infants and young children. Twenty-nine of initially 42 infants with recurrent wheeze (20 male and 9 female) with an age range of 2.1-25.2 months were randomly assigned to receive either 100 micrograms beclomethasone dipropionate (BDP) combined with 200 micrograms salbutamol (group BDP-S, n = 9), 200 micrograms salbutamol (group S, n = 8), or placebo (group P, n = 6) 3 times daily for a 6 weeks' treatment period. Six infants had to be treated openly with BDP-S (group O, n = 6) because of deterioration in the disease state. Ten babies were excluded because of incomplete data and poor drug compliance and further 3 because of needed rescue medication. The drugs were inhaled from a metered dose inhaler through a baby-adapted spacer device, the Babyhaler. Control was assessed by symptom diaries, and infant whole-body plethysmography. Values of thoracic gas volume (TGV), airway conductance (Gaw) and specific airway conductance (sGaw) were calculated numerically independent of age and body length in percent predicted and in standard deviation scores using regression equations taken from healthy infants previously evaluated. Functional improvement was considered to have occurred when either TGV, and/or Gaw improved more than 2 SD from baseline. There was a significant improvement in the symptom score (p < 0.05), particularly concerning cough, in addition to a significant decrease in pulmonary hyperinflation (TGV: p < 0.05) and improvement of Gaw (p < 0.01) and sGaw (p < 0.01) in the BDP-S group when compared to the P group. No significant differences were found between the BDP-S and S group and/or between the S and P groups.
                In wheezy infants BDP improves clinical status and lung function, when given in combination with salbutamol by a baby-adapted spacer device. The aim of this study was to investigate the role of oral salbutamol and prednisolone in the treatment of acute episodes of wheezing in infants under 15 months of age. Sixty-two acute episodes of wheezing were studied in 59 babies (age range 3-14 months; mean 7 months), who had all suffered at least one previous wheezy episode. Patients were randomised to receive either salbutamol and prednisolone, salbutamol and placebo or double placebo. Parents were requested to keep a diary card record of twice daily scoring of their baby's symptoms over the next 14 days. A significantly greater number of treatment failures occurred in the placebo group compared to babies treated with oral salbutamol (relative risk 2.51; 95% confidence intervals for relative risk 1.09-5.79). There was no difference in the number of treatment failures between babies treated with a combination of salbutamol and placebo and those treated with salbutamol and prednisolone (relative risk 0.71; 95% confidence intervals for relative risk 0.18-2.80).
                This study demonstrates that oral salbutamol is beneficial in the treatment of acute episodes of wheezing in infancy. A combination of oral salbutamol and oral prednisolone appeared to have no additional benefit over treatment with oral salbutamol alone. Nebulized albuterol (salbutamol) for the treatment of wheezy bronchitis was evaluated in a double-blind trial comprising 28 acutely ill children younger than 18 months and in 13 children 18 to 36 months of age. No significant difference in clinical effect was shown between albuterol and saline in the youngest group of children. Albuterol had some beneficial effect in children older than 18 months.