Conflicting Conclusions in 2 Bronchiolitis Studies; Editorial Explains Why

Less Improvement in Infants with Bronchiolitis After Nebulized Hypertonic Saline Treatment

Bottom Line: Children with bronchiolitis (a common respiratory tract infection that can result in hospitalization) who were treated in the emergency department showed less clinical improvement after receiving nebulized 3 percent hypertonic saline (HS) than infants who received normal saline (NS). 

Author: Todd A. Florin, M.D., M.S.C.E., of the Cincinnati Children’s Hospital, and colleagues. 

Background: Nebulized HS has been shown to increase mucociliary clearance (the clearing of mucus) in healthy people and in those patients with conditions such as asthma and cystic fibrosis because it is believed to lower the viscosity of mucus secretions. Other studies have suggested HS may reduce the length of hospital stays and lessen severity in children with bronchiolitis.

How the Study Was Conducted: The authors conducted a randomized clinical trial comparing nebulized 3 percent HS with NS in children presenting to the emergency department (ED) with acute bronchiolitis and continued distress after nasal suctioning and nebulized albuterol sulfate. The study included 62 children (from 2 to less than 24 months of age) with bronchiolitis at a single urban pediatric ED (31 children received 3 percent HS and 31 were given NS). The study was conducted from November through April in 2010 and 2011.

Results: At one hour after treatment, the HS group showed less improvement on a respiratory assessment score than children treated with NS. There were no differences in heart rate, oxygen saturation, hospitalization rate or other outcomes. 

Conclusion: “Based on the results of this and other studies, the administration of a single dose of 3 percent HS in the acute care setting does not appear to be more effective than NS in improving short-term respiratory distress in bronchiolitis.”

(JAMA Pediatr. Published online May 26, 2014. doi:10.1001/jamapediatrics.2013.5306.