Efficacy of adding ipratropium bromide and budesonide to nebulized salbutamol in the managenent of acute bronchiolitis in infants

Brenchiolitis is the most common lower respiratory tract infection in infants with considerably increased rate of its associated hospitalizations in the last years. To date there is no a single, widely practiced, evidence- driven treatment approach for bronchiolitis. Different treatment modalities have been in practice for some years, some of these therapies are specific to the virus and others are symptomatic. The bronchodilators and corticosteroids are the most commonly used drugs. Some studies found some benefit in the use of these drugs and others didn't found any beneficial effect of its use. Bronchodilators like salbutamol showed a better effect in bronchiohtis with more agreement in its use than the other drugs but also to a limited extent of efficacy. The aim of the present study was to evaluate the efficacy of using two different drugs [budesonide and ipratrobium bromide] in addition to salbutamol in the management of acute bronchiolitis in infants in trial to search for an effective medical treatment of this condition. This study was a randomized, double- blind controlled trial. The studied infants were divided into three groups by systematic random sample: group A received ipratrobium bromide inhalation and salbutamol, group B received budesomde and salbutamol inhalation, and group C received salbutamol alone. The primary outcome was symptom improvement and secondary outcomes i,'ere length of stay in hospital, adverse events, and report of symptoms by parents in revisit to outpatient clinic one week after discharge. As regarding to O2 saturation, there were no statistically significant differences between the studied groups. There were a significant difference in the mean length of hospital stay between groups A and B and between groups B and C, but no significant difference between groups A and C. There was no statistically significant difference in severity of respiratory symptoms which was measured by Respiratory Distress Assessment Instrument [RDAI] in the studied groups. There were a significant difference between group [A] and group [B] and between group [B] and group [C] as regarding to the presence of respiratory symptoms one week after discharge. These results demonstrate that ipratrobium bromide has no significant effect if added to salbutamol in the treatment of acute bronchiolitis in infants. Adding budesonide decreasing significantly the duration of stay in the hospital and the prevalence of symptoms one week after discharge but has no effect on other outcomes, with the conclusion that the use of budesonide with salbutamol in acute bronchiolitis is recommended to decrease the post hospitalization symptoms and the duration of hospitalization