Efficacy of nebulized normal saline with or without salbutamol in acute bronchiolitis: a retrospective cohort study

Background: Acute bronchiolitis is the leading cause of hospitalization in infants under one year of age. Despite international guidelines discouraging routine use of bronchodilators, substantial variation persists in clinical practice across different healthcare settings. To compare the clinical efficacy of nebulized normal saline alone versus nebulized saline combined with salbutamol in hospitalized infants with acute bronchiolitis. Methods: A single-center retrospective cohort study was conducted in infants less than 12 months old hospitalized for acute bronchiolitis. Eighty-one infants were stratified into two groups: nebulized 0.9% saline alone (n=40) and nebulized saline plus salbutamol (n=41). Primary outcome was clinical improvement at discharge, defined as sustained reduction in respiratory rate (≥10 breaths/min), resolution of retractions, and maintenance of oxygen saturation ≥94% for ≥6 hours. Secondary outcome was length of hospital stay. Baseline illness severity was quantified using a prospectively coded score. Statistical analysis included independent t-tests, chi-square tests, and multivariable regression models adjusted for age and baseline severity. Results: Clinical improvement rates were comparable between groups (75% in saline group vs 73% in saline plus salbutamol group; p=1.00; OR=1.10, 95% CI: 0.41–2.97). Mean length of hospital stay was 2.98±1.29 days in the saline group versus 3.44±1.42 days in the saline plus salbutamol group (p=0.127; Cohen's d=0.34). Multivariable logistic regression confirmed no significant treatment effect on clinical improvement after adjustment for baseline severity (adjusted OR=0.91, 95% CI: 0.34–2.46, p=0.85). Linear regression analysis revealed no significant effect of treatment on length of stay (adjusted β=0.467, p=0.132). Conclusions: Addition of salbutamol to nebulized saline conferred no clinical advantage over saline alone in the management of acute bronchiolitis in this cohort. These findings support current international evidence and guidelines recommending supportive care as the primary management strategy for bronchiolitis, regardless of the addition of bronchodilators. Implementation of standardized hospital protocols and continuing education may improve practice consistency.