Nebulized 3% Saline Without Adjunctive Bronchodilators May Be Safe for Bronchiolitis

News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Released: 08/16/2010; Valid for credit through 08/16/2011

August 16, 2010 — Nebulized hypertonic 3% saline solution without adjunctive bronchodilators has a low rate of adverse events in infants younger than 2 years with bronchiolitis, according to the results of a retrospective cohort study reported online August 16 in Pediatrics.

"Multiple studies evaluated nebulized hypertonic saline solution as a therapy for viral bronchiolitis in young children," write Shawn Ralston, MD, from University of Texas Health Science Center at San Antonio, and colleagues. "However, the available studies combined hypertonic saline solution with some form of bronchodilator because of theoretical concerns that hypertonic saline solution may cause bronchospasm.... This is the first study to investigate systematically the risk of bronchospasm or other significant adverse effects with hypertonic saline solution administered without bronchodilators for viral bronchiolitis."

The objective of the study was to assess the rate of adverse events for nebulized, 3% hypertonic saline solution given without bronchodilators to children younger than 2 years who were hospitalized with the primary diagnosis of bronchiolitis at a single academic medical center. The investigators reviewed medical charts for use of nebulized 3% saline solution, related adverse events, respiratory distress scores, timing of bronchodilator use relative to saline administration, transfer to higher-level care, and readmission within 72 hours after discharge.

The study authors used the phrase “without adjunctive bronchodilator” to indicate that the dose of 3% saline solution was administered without prior administration of a bronchodilator within 4 hours and without administration of a bronchodilator in the 4 hours immediately following the saline dose.

Of 444 total doses of 3% saline solution given, 377 doses (85%) were given without adjunctive bronchodilators, resulting in 4 adverse events (adverse event rate, 1.0%; 95% confidence interval [CI], 0.3% - 2.8%). In general, adverse events were mild except for 1 episode of bronchospasm (rate, 0.3%; 95% CI, < 0.01% - 1.6%).

"The use of 3% saline solution without adjunctive bronchodilators for inpatients with bronchiolitis had a low rate of adverse events in our center," the study authors write.

Limitations of this study include possible overreporting or underreporting of adverse events, retrospective design, possibly incomplete data, and lack of data regarding the efficacy of 3% saline solution.

"Additional clinical trials of 3% saline solution in bronchiolitis should evaluate the effectiveness of 3% saline solution in the absence of adjunctive bronchodilators, because these medications are not routinely indicated in bronchiolitis, on the basis of current evidence," the study authors conclude.

The study authors have disclosed no relevant financial relationships.

Pediatrics. Published online August 16, 2010.

source : http://cme.medscape.com/viewarticle/726941?src=cmemp&uac=97984HK

regards, taniafdi ^_^