The recommendation to not use bronchodilators is not supported by the evidence.

The guideline authors imply that our randomized controlled trial in 703 children with bronchiolitis supports their assertion that “clinical scores may vary from between observers”. This is a selective reading of our Limitations section. The cited article in fact showed an 18% (adjusted relative risk: 1.18; 95% confidence interval [CI]: 1.02–1.36) relative increase in successful hospital discharges from the emergency department (ED) when albuterol rather than epinephrine was administered. This study also addressed the limitations of consecutive enrollment with random allocation, previous episodes, and study site effect. The severity of illness tool we used has been validated and has adequate interrater agreement (92%; k 5 0.676).