Does albuterol treat pneumonia?

Many times in the hospital setting physicians order scheduled albuterol breathing treatments for patients admitted with pneumonia.  The question of the day is: does ventolin have any effect on pneumonia?

First of all, what is pneumonia?  Pneumonia is an inflammatory disease of the peripheral airways, particularly the alveolar (air) sacs.  The air sacs may become filled with fluid or pus, causing symptoms such as cough with colorful phlegm, fever, chills, and dyspnea.

So, what is the evidence that albuterol benefits pneumonia?  So far I have not been able to find any studies in this regard.  I am told there was a study done in the late 1980s, and the results were inconclusive.

Lacking studies, let's investigate the available wisdom.

1.  Pneumonia is an inflammatory disease.  To this date there is no evidence that albuterol has anti-inflammatory properties.

2.  Albuterol is attracted to beta 2 (B2) adrenergic receptors lining the smooth muscles that line the air passages in the lungs.  There is no evidence of smooth muscles in the alveoli, and no evidence of B2 receptors in the alveoli.

3.  Nebulizers are ideal for the inhalation of B2 adrenergic medicine because it creates aerosolized particles the size of 0.5 microns, an ideal size for medicine to get to the air passages.  For the medicine to get to the alveoli the nebulizer would have to produce aerosolized particles 0.1 to 02 microns.

4.  Pneumonia may cause a cough with increased secretions.  There is evidence that albuterol may increase mucociliary clearance and enhance cough.  However, in order to produce this effect a dose greater than the standard dose of 2.5 mg (0.5cc) would be necessary.  Studies regarding albuterol and mucociliary clearance were reviewed by Dr. Ruben D. in the September, 2007, issue of Respiratory Care, "Inhaled Adrenergics and Anticholinergics in Obstructive Lung Disease: Do They Enhance Mucociliary Clearance?"

5.  Some patients diagnosed with pneumonia who will claim to breathe easier after a treatment with albuterol.  However, the reason for this is because some patients with pneumonia present with bronchospasm secondary to pneumonia. The albuterol will treat the bronchospasm.  This is most likely to occur in patients with underlying or undiagnosed asthma.  While clinical evidence may suggests albuterol opens up air passages and breaks up secretions to enhance cough, no studies have been done to show this.

6. Cavallazzi R, et al shows that inhaled corticosteroids (mainly Budesonide) are the most widely used agents to treat pneumonia, as they are shown to have anti-inflammatory properties. They are generally recommended, with albuterol, to prevent COPD exacerbations in patients with severe COPD.  However, inhaled steroids may be systemically absorbed and have immonosuppresant effects.  The evidence that inhaled steroids may actually lead to pneumonia is modest.

7.  Systemic steroids are shown to reduce inflammation associated with pneumonia, and are a common treatment option. 

8.  Antibiotics are also frequently prescribed for pneumonia, considering most are caused by bacterial agents.

Conclusion:  There is no evidence that albuterol particles even make it to the alveoli, and even if they did make it there, there is no evidence they would produce any effect on the pneumonia. The best treatment for pneumonia should be inhaled or systemic steroids and antibiotics.

However, an initial treatment of albuterol may prove beneficial in opening up air passages when bronchospasm is present, and help break up secretions to enhance cough and expectoration.  This author recommends a trial and then PRN if the trial proves beneficial.