Why Albuterol Is No Longer Used for Bronchiolitis

Sad little girl receives breathing treatment.
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Bronchiolitis is a lower respiratory tract infection that commonly occurs in children under 2. It is usually caused by the respiratory syncytial virus (RSV), which triggers inflammation of the smaller air passages (bronchioles), resulting in wheezing and shortness of breath. RSV can cause severe infections in premature babies and children. If your child is at risk for RSV infection, your pediatrician may suggest Synagis (palivizumab).

Palivizumab is a shot that can help protect certain infants and children 2 years old and younger who are at high risk of serious complications from RSV. It's typically given once a month during the RSV season. Palivizumab is not a vaccine, and it cannot cure or treat a child who is already diagnosed with RSV.

Bronchiolitis is the leading cause of hospitalization in infants and young children. Since there is no cure for bronchiolitis, treatment is primarily aimed at alleviating symptoms of fever and breathing difficulties. If hospitalization is required, the treatment may also include supplemental oxygen and intravenous fluids to prevent dehydration.

In the past, the drug albuterol was commonly used in hospitals to help the child breathe. Albuterol is classified as a bronchodilator that works by relaxing muscles in the air passages. It is available in inhaled, oral, and injectable formulations and is commonly prescribed to people with chronic obstructive pulmonary disease (COPD) and asthma.

While it would seem reasonable to use albuterol in cases of severe bronchiolitis, updated guidance from the American Academy of Pediatrics (AAP) now recommends against its use.

Why the AAP Advises Against Albuterol

In their updated 2014 recommendations, the AAP acknowledged that albuterol can provide transient relief in children with bronchiolitis in the same way that it does asthma. However, the actual effectiveness of the drug in this scenario was largely subjective.

Research published in 2013 has shown that the use of albuterol in hospitalized children did nothing to improve outcomes or reduce hospital stays. Moreover, the AAP recommends against other treatments commonly used in the past, including nebulized hypertonic saline, systemic corticosteroids, antibiotics, and chest physiotherapy.

When to Go to the Hospital

Bronchiolitis in children will usually develop after two to three days of the common cold. It typically starts with nasal congestion and discharge, a mild cough, and a fever over 100.4 F.

If the infection progresses and the lower air passages are involved, the condition can become serious and lead to symptoms of:

  • Rapid breathing
  • Wheezing
  • Persistent coughing
  • Difficulty feeding
  • Gaps in breathing (apnea)

A parent will know that it's time to take the child to the emergency room if the wheezing lasts for more than seven days or progresses to grunting.

Another indication that a trip to the ER is warranted is if a child is using the muscles between the ribs or at the neck to take in breaths, is belly breathing (meaning the belly is going up and down severely with each breath), or cannot complete sentences without taking breaths in-between.

If the child weakens considerably and has a bluish tinge to the skin or lips (cyanosis), the parent should consider it a medical emergency and call 911.

Current Hospital Recommendations

Approximately 2-3% of all children will require hospitalization for bronchiolitis. Treatment involves the monitoring of vital signs and supportive care based on the child's condition and symptoms.

Supplemental oxygen may be needed for children who are unable to catch their breath. This is usually done by placing a tube, called a nasal cannula, under a child's nose or by using a face mask. For infants, an oxygen headbox may be used.

If the child is unable to eat or drink, either because the respiratory rate is too fast or breathing is severely impaired, fluids and nutrition may need to be delivered intravenously (into a vein).To prevent the spread of the virus, the child would be isolated from siblings and other children until the condition is fully resolved.

Most children hospitalized for bronchiolitis are well enough to return home after three to four days.

Frequently Asked Questions

  • Is Albuterol used for a COVID-19 cough?

    No, Albuterol is not used for a COVID-19 cough. In October 2020, the Food and Drug Administration (FDA) approved the use of a antiviral injection named Veklury (Remdesivir) to treat COVID-19 symptoms. The injection is administered by a healthcare professional for adults and children 12 years or older weighing at least 88 pounds.

  • How often can you use Albuterol?

    How often you can use Albuterol will depend on the instructions given by a healthcare provider. It also depends on the drug's intended purpose; for example, if Albuterol is meant to help with breathing during physical activity or exercise, it can be used 15 to 30 minutes beforehand. If someone uses it to relieve symptoms of a lung disease, they might take it every four to six hours. This frequency may vary from one person to another.

  • Does Albuterol help with congestion?

    No, Albuterol is not meant to help with congestion. Albuterol is a bronchodilator that is used as a treatment for people diagnosed with asthma or COPD. It can help prevent and relieve wheezing, chest tightness, coughing, and trouble breathing.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Pediatrics. Updated guidance: use of palivizumab prophylaxis to prevent hospitalization from severe respiratory syncytial virus infection during the 2022-2023 rsv season.

  2. Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134(5):e1474-502. doi:10.1542/peds.2014-2742

  3. Hall CB, Weinberg GA, Blumkin AK, et al. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics. 2013;132(2):e341-8. doi:10.1542/peds.2013-0303

  4. American Academy of Pediatrics. Bronchiolitis.

  5. Øymar K, Skjerven HO, Mikalsen IB. Acute bronchiolitis in infants, a review. Scand J Trauma Resusc Emerg Med. 2014;22:23. doi:10.1186/1757-7241-22-23

  6. U.S. Food and Drug Administration. FDA’s Approval of Veklury (Remdesivir) For the Treatment of COVID-19—the Science of Safety and Effectiveness.

  7. MedlinePlus. Remdesivir Injection.

  8. MedlinePlus. Albuterol.

By Vincent Iannelli, MD
 Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.