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(Chest. 2002;122:2015-2020.)
© 2002 American College of Chest Physicians

Nebulized 3% Hypertonic Saline Solution Treatment in Ambulatory Children With Viral Bronchiolitis Decreases Symptoms*

E. Michael Sarrell, MD; Guy Tal, MD; Michaela Witzling, MD; Eli Someck, MD; Sion Houri, MD; Herman A. Cohen and Avigdor Mandelberg, MD

* From the Pediatrics and Adolescent Ambulatory Community Clinic of General Health Services (Dr. Sarrell and Mr. Cohen), the Pediatric Pulmonary Unit (Drs. Tal and Mandelberg), the Department of Radiology (Dr. Witzling), the Unit of Pediatric Infectious Diseases (Dr. Someck), and the Pediatric Emergency Department (Dr. Houri), The Edith Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Correspondence to: Avigdor Mandelberg, MD, Director, Pediatric Pulmonary Unit, Department of Pulmonary Medicine and Pediatrics, The Edith Wolfson Medical Center, 62, Halochamim St, Holon 58100, Israel; e-mail: avigdorm{at}netvision.net.il

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 ].



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  		Figure 1. After the baseline measurement on the first day, the CS score differed significantly between the two groups: terbutaline/3% NaCl (treatment group) vs terbutaline/0.9% NaCl (control group). *p < 0.005. INH = inhalation.

 
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.

Key Words: ambulatory • ß2-agonist • hypertonic saline solution • respiratory syncytial virus • terbutaline • viral bronchiolitis






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