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Chest

Volume 122, Issue 6, December 2002, Pages 2015-2020
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Clinical Investigations: COPD
Nebulized 3% Hypertonic Saline Solution Treatment in Ambulatory Children with Viral Bronchiolitis Decreases Symptoms

https://doi.org/10.1378/chest.122.6.2015Get rights and content

Objective

To determine the utility of inhaled hypertonic saline solution to treat ambulatory infants with viral bronchiolitis.

Design

Randomized, double-blind, controlled trial. Sixty-five ambulatory infants (mean ± SD age, 12.5 ± 6 months) with viral bronchiolitis received either of the following: inhalation of 0.5 mL (5 mg) terbutaline added to 2 mL of 0.9% saline solution as a wet nebulized aerosol (control; group 1; n = 32) or 0.5 mL (5 mg) terbutaline added to 2 mL of 3% saline solution administered in the same manner as above (treatment; group 2; n = 33). This therapy was repeated three times every day for 5 days.

Results

The clinical severity (CS) scores at baseline on the first day of treatment were 6.4 ± 1.8 in group 1 and 6.6 ± 1.5 in group 2 (not significant). After the first day, the CS score was significantly lower (better) in group 2 as compared to group 1 on each of the treatment days (p < 0.005; Fig 1). On the first day, the percentage decrease in the CS score after inhalation therapy was significantly better for group 2 (33%) than for group 1 (13%) [p < 0.005; Fig 1]. On the second day, the percentage improvement was better in the hypertonic saline solution-treated patients (group 2) as compared to the 0.9% saline solution-treated patients (group 1) [p = 0.01; Fig 1].

Conclusions

We conclude that in nonasthmatic, nonseverely ill ambulatory infants with viral bronchiolitis, aerosolized 3% saline solution plus 5 mg terbutaline is effective in decreasing symptoms as compared to 0.9% saline solution plus 5 mg terbutaline.

Section snippets

Materials and Methods

This was a randomized, double-blinded, controlled trial. Signed informed consent was obtained from the parents of each child, and the human ethics committee of our hospital approved the study according to the principles of the Declaration of Helsinki. Seventy infants who presented to the Pediatrics and Adolescent Ambulatory Community Clinic of General Health Services of Petach-Tikva for acute viral bronchiolitis during the winter of 2000–2001 were recruited. The inclusion criterion was clinical

Results

Seventy previously healthy infants with viral bronchiolitis were enrolled in the study between December 2000 and March 2001. Their mean age was 12.5 ± 6 months (range, 3 to 24 months). Sixty-five infants completed the study. Five infants (7.1%) were hospitalized and therefore excluded from further evaluation. Of the 65 infants who took part in the final study analysis, 32 infants received 0.9% saline solution (0.5 mL [5 mg] terbutaline in 2 mL of 0.9% saline solution as a wet nebulized aerosol

Discussion

Our study shows that simply by substituting normal saline solution with hypertonic saline solution in the inhalation mixture for delivering terbutaline to ambulatory infants with mild-to-moderate viral bronchiolitis, we could decrease symptoms on every day of treatment (Fig 1). On the first and second days of treatment, we also demonstrated a significant immediate postinhalation improvement in CS score after terbutaline inhalation in hypertonic 3% saline solution as compared to terbutaline in

Conclusion

On the basis of a significantly improvement in CS score over control (0.9% saline solution), we conclude that the combination of hypertonic saline solution 3%/terbutaline is an effective medication for ambulatory infants with relatively mild acute bronchiolitis. This treatment has an excellent safety profile when compared to terbutaline diluted in normal saline solution.

ACKNOWLEDGMENT

Mona Boaz, MSc, biostatistician of the Edith Wolfson Medical Center, Holon, advised on statistics.

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    Copyright © 2002 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.