The efficacy of nebulized salbutamol, hypertonic saline and salbutamol/hypertonic saline combination in moderate bronchiolitis

İpek, İlke Özahı; Yalçın, Emek Uyur; Sezer, Rabia Gönül; Bozaykut, Abdülkadir

doi:10.1016/j.pupt.2011.09.004

Cited by 49 publications

(63 citation statements)

References 23 publications

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“…1 In conclusion, we agree with the AAP guidelines 1 regarding the use of nebulized hypertonic saline to reduce bronchiolitis scores and LOS for infants with bronchiolitis who are expected to be hospitalized for more than 72 hours. We also note that recent trials [21][22][23][24][25][26][27][28][29][30][31] suggest that hypertonic saline reduces admission rates from the ED, and we believe there may be a role for hypertonic saline in this setting. Given the safety of this therapy and the lack of other effective therapies for these patients, use of hypertonic saline should be attempted in multiple doses in all patient care settings where nebulization can be administered.…”

Section: Clinical Trials Evaluating Hypertonic Saline Use In Hospitalsmentioning

confidence: 74%

“…26,28,30,31 The determination by the AAP that hypertonic saline is not effective in this setting is intriguing in light of the effectiveness of both forms of saline (NS and hypertonic saline) in these trials.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…This study found trends in improvements with hypertonic saline in bronchiolitis scores and hospitalization rates; however, according to their power analysis the authors did not enroll a sufficient number of patients to detect significant differences. In 2011, Ipek et al 28 conducted a prospective, randomized, double-blind study to investigate the therapeutic benefit of nebulized 3% hypertonic saline for the treatment of bronchiolitis in the ED. The study investigated 4 different regimens: 1) albuterol 0.15 mg/kg plus NS; 2) albuterol 0.15 mg/kg plus 3% hypertonic saline; 3) 3% hypertonic saline alone; or 4) NS alone.…”

Section: In Ns)mentioning

confidence: 99%

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Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

Baron

El-Chaar

2016

The Journal of Pediatric Pharmacology and Therapeutics

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Bronchiolitis, an infection of the lower respiratory tract, is the leading cause of infant and child hospitalization in the United States. Therapeutic options for management of bronchiolitis are limited. Hypertonic saline inhalation therapy has been studied in numerous clinical trials with mixed results. In 2014, the American Academy of Pediatrics (AAP) published updated guidelines on the diagnosis and management of bronchiolitis, which include new recommendations on the use of hypertonic saline. We reviewed all published clinical trials mentioned in the 2014 AAP guidelines, as well as additional trials published since the guidelines, and critically evaluated each trial to determine efficacy, safety, and expectations of hypertonic saline inhalation therapy. A total of 2682 infants were studied over the course of 22 clinical trials. Nine trials were carried out in the outpatient/clinic/emergency department and 13 in the inpatient setting. We agree with the AAP guidelines regarding the recommendation to use nebulized hypertonic saline for infants hospitalized with bronchiolitis, with the expectation of reducing bronchiolitis scores and length of stay when it is expected to last more than 72 hours. However, we also believe there might be an advantage for hypertonic saline in reducing admission rates from the emergency department, based on close examination of the results of recent trials. This review also highlights important gaps in the available literature that need to be addressed in order to define the role of inhaled hypertonic saline therapy.INDEX TERMS: bronchiolitis, hypertonic saline, infants, pediatrics, review J Pediatr Pharmacol Ther 2016;21(1):7-26

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Section: Clinical Trials Evaluating Hypertonic Saline Use In Hospitalsmentioning

confidence: 74%

Section: Discussion/conclusionmentioning

confidence: 99%

Section: In Ns)mentioning

confidence: 99%

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Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

Baron

El-Chaar

2016

The Journal of Pediatric Pharmacology and Therapeutics

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“…9 Over the past decades, a growing number of randomized trials have been undertaken to assess the effects and safety of nebulized HS in infants with acute bronchiolitis. [10][11][12][13][14][15][16][17][18][19] The Cochrane review published in 2013 including 11 randomized trials shows that nebulized 3% saline may significantly reduce the length of stay (LOS) in hospitalized infants with acute bronchiolitis and improve the clinical severity score (CSS) in both outpatient and inpatient populations. 20 Since then, new trials with conflicting results have been published, and an updated synthesis of the literature is needed.…”

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confidence: 99%

Nebulized Hypertonic Saline for Acute Bronchiolitis: A Systematic Review

et al. 2015

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“…Thus the ideal treatment has to decrease submucosal edema and improve mucociliary clearance by restoring the elasticity and viscosity of the mucus. In the last decade, 3% and 5% hypertonic saline (HS) studied in infants with bronchiolitis with good results (8)(9)(10)(11)(12)(13)(14). In the light of cystic fibrosis studies, it was shown that 7% HS increases mucociliary clearance and decreases epithelial edema (15-17).…”

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confidence: 99%

Comparing the Efficacy of 7%, 3% and 0.9% Saline in Moderate to Severe Bronchiolitis in Infants

et al. 2016

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Background:There is no standard treatment option in acute bronchiolitis. 3-7% hypertonic saline (HS) seems to be the effective treatment choice for reducing the hospitalization day. Aims: To compare the effect of nebulized 7% HS/ salbutamol and 3% HS/salbutamol to 0.9% saline/ salbutamol. The primary outcome measure was the effect of study drugs on the length of hospital stay (LOS). Secondary outcome measures were safety and efficacy in reducing the clinical severity score (CSS) at the 24 hours of the study. Study Design: Prospective, double-blinded randomized clinical study. Methods: The study consists of 104 infants. Groups were constituted according to the treatment they received: These are, group A -0.9% saline/salbutamol, group B -3% HS/salbutamol and group C-7% HS/salbutamol. Heart beat, Bronchiolitis CSS and oxygen saturation of the patients were determined before and after nebulization. The patients were monitored for adverse reactions. Results: Length of hospital stay in group A, B and C were as follows; 72.0 (20-288) hours in group A, 64.0 (12-168) hours in group B and 60.0 (12-264) hours in group C. No significant differences was observed among three groups (p>0.05). Conclusion: 7% HS and 3% HS does not have any effect to decrease LOS for infants with bronchiolitis. Keywords: Bronchiolitis, hypertonic saline, infant Copyright 2016 © Trakya University Faculty of Medicine Balkan Med J 201633:193-7 Comparing Bronchiolitis is the most frequent viral lower respiratory tract infection seen in infancy period characterized by cough, wheezing and tachypnea. Bronchiolitis is the major reason of infant hospitalization in both developed and developing countries. Although it is common there is no current standard treatment. Supportive care is the only evidence based treatment option (1,2). Many studies focused on testing the effects of bronchodilators such as β2-agonsits (3), epinephrine (4), glucocorticoids (5) and magnesium sulfate (6) with controversial results.There exists the first necrosis of the respiratory epithelium in bronchiolitis. Following by the fact that, exaggerated mucus production occurs due to the proliferation of goblet cells. On the other hand epithelial regeneration with nonciliated cells happens thus decreasing mucociliary clearance. Lymphocytic infiltration may result in submucosal edema (7). Johnson et al. (7) demonstrated that, airway obstruction in bronchiolitis was because of epithelial and inflammatory cell debris. And they did not observe bronchial smooth muscle constriction. This can explain why bronchodilator therapy is not effective in bronchiolitis. Thus the ideal treatment has to decrease submucosal edema and improve mucociliary clearance by restoring the elasticity and viscosity of the mucus. In the last decade, 3% and 5% hypertonic saline (HS) studied in infants with bronchiolitis with good results (8)(9)(10)(11)(12)(13)(14). In the light of cystic fibrosis studies, it was shown that 7% HS increases mucociliary clearance and decreases epithelial edema (15-17). Thus,

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The efficacy of nebulized salbutamol, hypertonic saline and salbutamol/hypertonic saline combination in moderate bronchiolitis

Cited by 49 publications

References 23 publications

Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

Nebulized Hypertonic Saline for Acute Bronchiolitis: A Systematic Review

Comparing the Efficacy of 7%, 3% and 0.9% Saline in Moderate to Severe Bronchiolitis in Infants

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