Reducing Albuterol Use in Children With Bronchiolitis

Pediatrics. 2020 Jan;145(1):e20190306. doi: 10.1542/peds.2019-0306. Epub 2019 Dec 6.


Objectives: In 2014, the American Academy of Pediatrics published bronchiolitis guidelines recommending against the use of bronchodilators. For the winter of 2015 to 2016, we aimed to reduce the proportion of emergency department patients with bronchiolitis receiving albuterol from 43% (previous winter rate) to <35% and from 18% (previous winter rate) to <10% in the inpatient setting.

Methods: A team identified key drivers of albuterol use and potential interventions. We implemented changes to our pathway and the associated order set recommending against routine albuterol use and designed education to accompany the pathway changes. We monitored albuterol use through weekly automated data extraction and reported results back to clinicians. We measured admission rate, length of stay, and revisit rate as balancing measures for the intervention.

Results: The study period included 3834 emergency department visits and 1119 inpatient hospitalizations. In the emergency department, albuterol use in children with bronchiolitis declined from 43% to 20% and was <3 SD control limits established in the previous year, meeting statistical thresholds for special cause variation. Inpatient albuterol use decreased from 18% to 11% of patients, also achieving special cause variation and approaching our goal. The changes in both departments were sustained through the entire bronchiolitis season, and admission rate, length of stay, and revisit rates remained unchanged.

Conclusions: Using a multidisciplinary group that redesigned a clinical pathway and order sets for bronchiolitis, we substantially reduced albuterol use at a large children's hospital without impacting other outcome measures.

MeSH terms

  • Albuterol / therapeutic use*
  • Bronchiolitis / drug therapy*
  • Bronchodilator Agents / therapeutic use*
  • Critical Pathways
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Health Services Needs and Demand / statistics & numerical data
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Infant, Newborn
  • Length of Stay*
  • Male
  • Medical Overuse / prevention & control
  • Outcome Assessment, Health Care
  • Patient Admission / statistics & numerical data*
  • Practice Guidelines as Topic
  • Quality Improvement
  • Seasons


  • Bronchodilator Agents
  • Albuterol