Nebulized Albuterol in Hypertonic Saline Rather than Normal Saline May Reduce Hospitalizations in Young Children with Acute Wheezing

DynaMed Weekly Update - Volume 7, Issue 27

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Virus-induced wheezing is a common cause of emergency department (ED) visits for young children, and symptoms often do not respond to bronchodilators and corticosteroids (N Engl J Med 2009 Jan 22;360(4):339, N Engl J Med 2009 Jan 22;360(4):329). There is previous evidence that nebulized hypertonic saline either alone or mixed with epinephrine may improve outcomes in infants with bronchiolitis (Cochrane Database Syst Rev 2011 Mar 16;(3):CD006458, J Pediatr 2010 Oct;157(4):630). A new small randomized trial evaluated the effects of adding hypertonic saline to albuterol in 41 children aged 1-6 years visiting the ED with acute wheezing episodes. Following a single inhalation of albuterol with normal saline, children were randomized to albuterol mixed with hypertonic saline 5% vs. albuterol mixed with normal saline. The study drug was given twice in the ED with 20 minutes between doses and then 4 times daily if the child was admitted to the hospital. Children with viral bronchiolitis were excluded.

Albuterol with hypertonic saline was associated with a significant reduction in hospital admission compared to albuterol plus normal saline (62.2% vs. 92%, p< 0.05, NNT 4) The median hospital stay was 2 days with hypertonic saline vs. 3 days with normal saline (p = 0.027). Clinical severity scores were significantly reduced in both groups compared to baseline, with no significant differences between groups (Pediatrics 2012 Jun;129(6):e1397).

For more information, see the Acute Bronchitis topic in DynaMed.