Intravenous Terbutaline as Rescue Therapy in Severe Bronchiolitis: A Report of Two Cases

Abstract

Bronchiolitis is a lower respiratory tract infection most frequently caused by viral infections and is usually managed with supportive care. The role of bronchodilators particularly intravenous (IV) β2-agonists remain uncertain. Emerging evidence suggests that bronchiolitis comprises heterogeneous phenotypes, with a subset demonstrating bronchodilator responsiveness. We report two infants (ten and three months old) with RSV confirmed severe bronchiolitis who exhibited respiratory distress and hypoxemia despite maximal supportive therapy, including oxygen, continuous positive airway pressure (CPAP), corticosteroids and inhaled salbutamol. IV terbutaline was initiated as rescue therapy after failure of supportive treatment and titrated up to 0.4 µg/kg/min resulting in progressive improvement in clinical respiratory scores, resolution of wheeze, and normalization of oxygen saturation within 24-48 hours. No adverse effects were observed. These case reports highlight the potential role of IV terbutaline as a rescue therapy in selected infants with bronchiolitis associated bronchospasm and warrant further well designed larger prospective studies.