Effect of Salbutamol on Respiratory Mechanics in Bronchiolitis

The effect of inhaled bronchodilators in bronchiolitis has been difficult to evaluate due to problems with techniques for assessing respiratory function in infants. Two new techniques were used to assess the response to inhaled salbutamol in 17 infants with bronchiolitis. With one technique, expiratory flow, volume, and airway occlusion pressure were measured and used to derive compliance (Crs) and conductance (Grs) of the respiratory system from a passive expiration induced by a brief end-inspiratory airway occlusion. With the other technique, the maximum flow at functional residual capacity (VmaxFRC) was measured from a partial maximum expiratory flow-volume curve generated by external chest compression. For the group, there was no change in compliance or conductance after salbutamol, but salbutamol caused a fall in maximum flow at functional residual capacity (p< 0.01) and in the time constant of tidal expiration (p< 0.01). The decrease in maximum flow at functional residual capacity with salbutamol is consistent with increased airway collapse on forced expiration. The decrease in tidal time constant suggests that the drug decreases expiratory braking. Presence of such braking activity may be an important strategy for maintaining lung volume. In summary, salbutamol failed to produce a beneficial effect on airways in bronchiolitis, but did produce changes in expiration which may be harmful in some infants.