A comparative study of inhalational therapy versus supportive management in children aged 2 months to 2 years suffering from acute bronchiolitis

Shaik Nazeer Ahmed, Suman Poosala


Background: The study was conducted with the aim to compare the effectiveness of nebulized hypertonic (3%) saline and nebulized salbutamol over supportive management to assess and monitor the clinical response in the above three modalities of management, to compare the length of stay in the hospital and to identify the risk factors for severe disease.

Methods: This descriptive, cross-sectional hospital-based study was conducted at RICH Pediatric Hospital, Pogathota, Nellore, Andhra Pradesh from January 2015 to October 2016. A total of 120 children were included in the study. They were randomized into three treatment groups consisting of 40 in each. Group A received only supportive management, Group B received nebulization with 4 ml of 3% hypertonic saline along with supportive management and Group C received nebulization with 2.5 ml (2.5 mg) of salbutamol along with supportive management. Nebulization were given at intervals of 4 hours, six times a day until the patient was ready for discharge. Data was entered in Microsoft excel and analysis was done using SPSS version. A p-value of <0.05 was considered to be statistically significant.

Results: Out of 120 children involved in the study, majority 56 (46.66%) children were <6 months age. Male preponderance was observed in the study (M:F-1.4:1). Higher proportion of moderate to severe cases was from rural area (61 cases). More severe cases were seen in lower socioeconomic class people and who had history of second hand smoking (21.67%). Clinically better improvement was seen in children that received nebulized hypertonic saline along with supportive management with mean length of hospital stay of 2.5 days when compared to only supportive management with mean length of hospital stay of 3.25 days. The mean length of hospital stays with nebulized salbutamol along with supportive management is 3.05 days which is not clinically significant. Of the 120 children studied, 118 (98.33%) survived and were discharged, while 2 children who presented critically succumbed to death (1.67%).

Conclusions: Therapy with nebulized 3% hypertonic saline reduced the length of hospital stay in children <2 years suffering from acute bronchiolitis. Due to the efficacy and cost-effectiveness of the treatment, nebulized hypertonic saline should be considered for clinical management of acute bronchiolitis in children <2 years.


Acute bronchiolitis, Supportive management, Inhalational therapy

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Hasegawa K, Tsugawa Y, Brown DF, Mansbach JM, Camargo CA Jr. Trends in bronchiolitis hospitalizations in the US, 2000-2009. Pediatr. 2013;132:28.

Yorita KL, Holman RC, Sejvar JJ, Steiner CA, Schoberger LB. Infectious disease hospitalizations among infants in the US. Pediatr. 2008;121:244-52.

Swingler GH, Hussey GD, Zwarenstein M. Duration of illness in ambulatory children diagnosed with bronchiolitis. Arch Pediatr Adolesc Med. 2000;154:997.

Thompson M, Vodicka TA, Blair PS, Buckley DI, Heneghan C, Hay AD. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ. 2013;347:7027.

Mansbach JM, Piedra PA, Teach SJ, Sullivan AF, Forgey T, Clark S, et al. Prospective multicentre study of viral etiology and hospital length of stay in children with severe bronchiolitis. Arch Pediatr Adolesc Med. 2012;166:700.

Jartti T, Aakula M, Mansbach JM, Piedra PA, Bergroth E, Koponen P, et al. Hospital length of stay is associated with rhinovirus etiology of bronchiolitis. Pediatr Infect Dis J. 2014;33:829.

Piedimonte G, Perez MK. Respiratory syncytial virus infection and bronchiolitis. Paediatrics Rev. 2014;35(12):519-28.

Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev. 2013: CD004878.

Wang EE, Milner RA, Navas L, Maj H. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. Am Rev of Resp Dis. 1992;145(1):106-9.

Deshpande SA, Northern V. The clinical and health economic burden of respiratory syncytial virus disease in children under 2 years of age. Arch Dis Child. 2003;88;1065-9.

Bush A, Thomson AH. Acute bronchiolitis. BMJ. 2007;335:1037-41.

Langley JM, LeBlanc JC, Smith B, Wang EL. Increasing incidence of hospitalization for bronchiolitis among Canadian children. J Infect Dis. 2003;188(11):1764-7.

Shakil A, Sadida A, Shahbaz A. Acute bronchiolitis in children. Professional Med J. 2013;20(5);707-12.

McConnochie KM, Roghmann KJ. Parental smoking, presence of older siblings, and family history of asthma increase risk of bronchiolitis. Am J Dis Child. 1986;140:806.

Farzana R, Hoque M, Kamal MS, Choudhury MU. Role of parental smoking in severe bronchiolitis: a hospital-based case-control study. Int J Pediatr. 2017;9476367.

Iqbal SMJ, Afzal MF, Sultan MA. Acute bronchiolitis: epidemiological and clinical study. Ann. 2009;15(4):203-5.

Luo Z, Fu Z, Liu E, Xu X, Fu X, Peng D, et al. Nebulized hypertonic saline treatment in hospitalized children with moderate to severe viral bronchiolitis. Clin Microbial Infect. 2011;17(12):1829-33.

Kuzik BA, Al-Qadhi SA, Kent S, Flavin MP, Hopman W, Hotte S, et al. Nebulized hypertonic saline in the treatment of viral bronchiolitis in infants. J Pediatr. 2007;151:266-70.