Comparison of the efficacy of hypertonic saline (3%) with salbutamol nebulization for treatment of acute bronchiolitis: a randomized clinical trail
DOI:
https://doi.org/10.18203/2349-3291.ijcp20250756Keywords:
Acute bronchiolitis, Hypertonic saline, Nebulization, SalbutamolAbstract
Background: Acute bronchiolitis is a common respiratory condition in infants and nebulized solutions are often used as part of its management. This study compares the efficacy and safety of nebulized 3% hypertonic saline (HS) versus salbutamol with normal saline (NS) in treating bronchiolitis.
Methods: This was a Randomized controlled trial conducted in the Department of Pediatrics of Chattogram Medical College Hospital and Chattogram Maa- O- Shishu Hospital, Chattogram, Bangladesh, during the period from February 2018 to February 2019. We included 204 children and divided them into two groups – Group A (Children who were given nebulized 3% HS (4 ml) with an oxygen flow rate of 6-8 l/min) and group B (Children who were given nebulized salbutamol in a dose of 0.15 mg/kg body weight in normal saline).
Results: The mean age of patients was comparable between groups (8.54±4.41 vs. 8.25±4.46 months, p=0.644). Both groups had a male predominance (63.7% vs. 62.7%, p=0.885). Baseline clinical characteristics, including respiratory rate, heart rate, temperature and oxygen saturation, were similar across groups. At 72 hours, CSS showed significant improvement in both groups (p<0.001), with a greater reduction in the HS group (Group A) compared to the salbutamol group (Group B) (p=0.034). LOS was significantly shorter in the HS group, with 82.35% discharged within 72 hours compared to 55.9% in the salbutamol group (p=0.013). No adverse events were reported in either group.
Conclusions: Nebulized 3% hypertonic saline demonstrated greater efficacy in reducing clinical severity scores and shortening hospital stays compared to salbutamol with normal saline, with no adverse events reported. This suggests that 3% HS is a safe and effective option for the management of acute bronchiolitis in infants.
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References
Hasan MR, Hossain MA, Mahmud MA. National Guidelines for Asthma, Bronchiolitis and COPD. Asthma Association Bangladesh, Dhaka, Bangladesh. 2005.
Coates BM, Lauren L, Goodman CM, Goodman DM. Wheezing in infants in bronchiolitis. In: Kliegman RM, editor. Nelson Textbook of Pediatrics. 20th ed. Reed Elsevier India Private Limited, New Delhi. 2016.
Maraqa NF, Steele RS. Bronchiolitis. Available at: https://emedicine.medscape.com. Accessed on 21 November 2024.
Hasan R, Rhodes J, Thamthitiwat S, Olsen SJ, Prapasiri P, Naorat S, et al. Incidence and etiology of acute lower respiratory tract infections in hospitalized children younger than 5 years in rural Thailand. Pediatr Infect Dis J. 2014;33(2):45–52. DOI: https://doi.org/10.1097/INF.0000000000000062
Kabir ARLM, Amin MR, Mollah MAH, Khanam S, Mridha AA, Ahmed S, et al. Respiratory disorders in under-five children attending different hospitals of Bangladesh: A cross-sectional survey. J Respir Med Res Treat. 2016;5:1835.
Shi T, McAllister DA, O’Brien KL, Simoes EAF, Madhi SA, Gessner BD, et al. Global, regional and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: A systematic review and modelling study. Lancet. 2017;390(10098):946–58. DOI: https://doi.org/10.1016/S0140-6736(17)30938-8
Willson DF, Landrigan CP, Horn SD, Smout RJ. Complications in infants hospitalized for bronchiolitis or respiratory syncytial virus pneumonia. J Pediatr. 2003;143(5):142–9. DOI: https://doi.org/10.1067/S0022-3476(03)00514-6
Thorburn K. High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis. Thorax. 2006;61(7):611–5. DOI: https://doi.org/10.1136/thx.2005.048397
Openshaw PJM, Tregoning JS. Immune responses and disease enhancement during respiratory syncytial virus infection. Clin Microbiol Rev. 2005;18(3):541–55. DOI: https://doi.org/10.1128/CMR.18.3.541-555.2005
Randell SH, Boucher RC. Effective mucus clearance is essential for respiratory health. Am J Respir Cell Mol Biol. 2006;35(1):20–8. DOI: https://doi.org/10.1165/rcmb.2006-0082SF
Mandelberg A, Amirav I. Hypertonic saline or high volume normal saline for viral bronchiolitis: Mechanisms and rationale. Pediatr Pulmonol. 2010;45(1):36–40. DOI: https://doi.org/10.1002/ppul.21185
Wark P, McDonald VM. Nebulized hypertonic saline for cystic fibrosis. Cochrane Database Syst Rev. 2009;2:67-9. DOI: https://doi.org/10.1002/14651858.CD001506.pub3
Mandelberg A, Tal G, Witzling M, Someck E, Houri S, Balin A, et al. Nebulized 3% hypertonic saline solution treatment in hospitalized infants with viral bronchiolitis. Chest. 2003;123(2):481–7. DOI: https://doi.org/10.1378/chest.123.2.481
Sarrell EM, Tal G, Witzling M, Someck E, Houri S, Cohen HA, et al. Nebulized 3% hypertonic saline solution treatment in ambulatory children with viral bronchiolitis decreases symptoms. Chest. 2002;122(6):2015–20. DOI: https://doi.org/10.1378/chest.122.6.2015
Wang EEL, Milner RA, Navas L, Maj H. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. Am Rev Respir Dis. 1992;145(1):106–9. DOI: https://doi.org/10.1164/ajrccm/145.1.106
Iwane MK, Edwards KM, Szilagyi PG, Walker FJ, Griffin MR, Weinberg GA, et al. Population-based surveillance for hospitalizations associated with respiratory syncytial virus, influenza virus and parainfluenza viruses among young children. Pediatrics. 2004;113(6):1758–64. DOI: https://doi.org/10.1542/peds.113.6.1758
Islam KT, Mollah AH, Matin A, Begum M. Comparative efficacy of nebulized 3% hypertonic saline versus 0.9% normal saline in children with acute bronchiolitis. Bangladesh J Child Health. 2018;42(2):130–7. DOI: https://doi.org/10.3329/bjch.v42i3.39264
Gupta HV, Gupta VV, Kaur G, Baidwan AS, George PP, Shah JC, et al. Effectiveness of 3% hypertonic saline nebulization in acute bronchiolitis among Indian children: A quasi-experimental study. Perspect Clin Res. 2016;7(2):88–93. DOI: https://doi.org/10.4103/2229-3485.179434
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(3):266–70. DOI: https://doi.org/10.1016/j.jpeds.2007.04.010
Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebulized hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev. 2013;4:89-91. DOI: https://doi.org/10.1002/14651858.CD006458.pub3
Grewal S, Ali S, McConnell DW, Vandermeer B, Klassen TP. A randomized trial of nebulized 3% hypertonic saline with epinephrine in the treatment of acute bronchiolitis in the emergency department. Arch Pediatr Adolesc Med. 2009;163(11):45-9. DOI: https://doi.org/10.1001/archpediatrics.2009.196
Wu S, Baker C, Lang ME, Schrager SM, Liley FF, Papa C, et al. Nebulized hypertonic saline for bronchiolitis. JAMA Pediatr. 2014;168(7):657. DOI: https://doi.org/10.1001/jamapediatrics.2014.301
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(4):630-4. DOI: https://doi.org/10.1016/j.jpeds.2010.04.074
Anil AB, Anil M, Saglam AB, Cetin N, Bal A, Aksu N. High-volume normal saline alone is as effective as nebulized salbutamol-normal saline, epinephrine-normal saline and 3% saline in mild bronchiolitis. Pediatr Pulmonol. 2010;45(1):41–7. DOI: https://doi.org/10.1002/ppul.21108
Luo Z, Liu E, Luo J, Li S, Zeng F, Yang X, et al. Nebulized hypertonic saline/salbutamol solution treatment in hospitalized children with mild to moderate bronchiolitis. Pediatr Int. 2010;52(2):199–202. DOI: https://doi.org/10.1111/j.1442-200X.2009.02941.x