Bronchiolitis (part 2 of 2)

23 September, 2010 by: colinparker

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Nebulised Hypertonic Saline… Everybody’s talking about it. Well, they should be. Is this finally the treatment for bronchiolitis that we’ve been waiting for? Could a cheap, simple medication like this be the answer to massive health-care costs?

Bronchiolitis is such a common condition, that saving a day (or even half a day) of hospital length of stay across the board, would result in major savings to healthcare costs, across the world.
If this was a new or patented drug, we would have heard all about it!
In this episode we discuss 4 original papers related to Hypertonic Saline for bronchiolitis, as well as the reviews riding on these original works.

Nebulised Hypertonic Saline for Bronchiolitis: Outline of this PEMcast

CP: welcome, disclaimer, overview

CP: Sarrell 2002: Nebulized 3% hypertonic saline solution treatment in ambulatory children with viral bronchiolitis decreases symptoms. [Chest 2002; 122: 2015-20]

SF: Mandelberg 2003: Nebulized 3% hypertonic saline solution treatment in hospitalized infants with viral bronchiolitis. [Chest 2003; 123: 481-7]

KB: Tal 2006: Hypertonic saline / epinephrine treatment in hospitalized infants with viral bronchiolitis reduces hospitalization stay: 2 years experience. [Israeli Medical Association Journal 2006; 8: 169-73]

CP: Kuzik 2007: Nebulized hypertonic saline in the treatment of viral bronchiolitis in infants. [Journal of Pediatrics 2007; 151: 266-70]

SF: Zhang 2008 Cochrane review: Nebulized hypertonic saline solution for acute bronchiolitis in infants. [Cochrane Database of Systematic Reviews 2008; CD006458]

KB: Horner 2009 BestBET: Nebulised hypertonic saline significantly decreases length of hospital stay and reduces symptoms in children with bronchiolitis. [Emergency medicine Journal 2009; 26: 518-9]

CP: summary / opinions of others

All: conclusions, goodbye

Thanks for joining us… Post a comment! Are you using hypertonic saline nebs for bronchiolitis?

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4 Responses to “Bronchiolitis (part 2 of 2)”
  1. Colin says:

    Two more papers on Hypertonic Saline in Bronchiolitis have emerged this year.

    The first by Ralston, Hill and Martinez was published online in Pediatrics in August 2010 – a retrospective cohort study which showed a low rate of adverse events when nebulised hypertonic saline was given without adjunctive bronchodilators:
    Ralston S, Hill V, Martinez M. Nebulized hypertonic saline without adjunctive
    bronchodilators for children with bronchiolitis. Pediatrics. 2010; 126:e520-5.

    The second paper by Al-Ansari and colleagues prospectively compared 5% hypertonic saline to normal saline. Unfortunately the patient group may not be representative of our usual bronchiolitis patients, with a median age of 3 months, relatively less severe disease, and relatively late enrolment (around 4 days of prior symptoms):
    Al-Ansari K, Sakran M, Davidson BL, El Sayyed R, Mahjoub H, Ibrahim K.
    Nebulized 5% or 3% hypertonic or 0.9% saline for treating acute bronchiolitis in
    infants. J Pediatr. 2010; 157: 630-4, 634.e1.

  2. Sing T says:

    Hi Colin
    I just came across a recent paper on the effect of inhaled hypertonic saline on hospital admission rate in children with bronchiolitis – a randomised trial. Unfortunately it was under powered; they only recuited about half the number of patients required during a single bronchiolitis season. 81 patients, <24mo children with moderately severe bronchiolitis (mean age 8.9mo), 3% hypertonic saline vs 0.9% Normal saline (both with 1mg Ventolin) Nebulised 3x consecutively. Same day admission rate was 18% vs 27% respectively and was not statistically significant, although there was a trend towards decreased admission rate and improvement in respiratory distress score in 3% hypertonic saline group.

    Kuzik BA, Flavin MP, Kent S, Zielinski D, Kwan CW, Adeleye A, Vegsund BC, Rossi C.
    Effect of inhaled hypertonic saline on hospital admission rate in
    children with viral bronchiolitis: a randomized trial.
    CJEM. 2010; 12:477-84.

  3. colinparker says:

    Thanks Sing
    I know you don’t believe in this treatment… Maybe some good-quality studies in the future will show us whether it really works or not.

  4. Casey Parker says:

    Hi Colin
    Love the site
    I have used your hypertonic saline for bronch podcast as a link on my latest posting at Broome Docs.
    Keep it up


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