Thread by @apsmunro

Now we’re entering bronchiolitis season, and everyone starts getting antsy about hearing wheeze and not immediately drowning children in salbutamol, because “what’s the harm?”, here is a quick tweetorial on why it doesn’t work and why it definitely CAN cause harm 1/5

What is salbutamol? It’s an adrenoreceptor agonist, selective for beta 2 receptors. It works by reversing brochoconstriction.

In bronch obstruction is usually not caused by bronchoconstriction, but by inflammation and mucous plugging, therefore salbutamol = not useful 2/5

What’s the harm?

When you have poor oxygenation of areas of lung tissue, the blood vessels in these areas constrict to divert blood away and prevent “shunting” - blood leaving the lungs without oxygen. Clever eh?

But oh no... 3/5

Salbutamol is only selective for beta 2 receptors, and also agonises other adrenoreceptors! In lung vessels this causes vasodilation, and can open these previously constricted vessels in the lungs, causing shunting and rapidly dropping sats 4/5

So next time you’re feeling twitchy with a wheezy bronchi baby, just make a cup of tea, sit on your hands, and do nothing.

It doesn’t help, and can precipitously drop sats, causing them to turn blue and your pants to turn brown!

Finis 5/5