NEW YORK (Reuters Health) – Adding hypertonic saline inhalation to bronchodilator therapy for young children seen in the emergency department with acute wheezing reduces admission rates and lengths of stay, an Israeli team reports in the June issue of Pediatrics.

“These results could have an important clinical impact on the way we treat many wheezing preschool children,” comment Dr. Avigdor Mandelberg, at the Edith Wolfson Medical Center in Holon, and colleagues.

They point out that preschool children with acute wheezing respond poorly to available treatments, including oral steroids. Noting that rhinovirus infection, the most cause of wheezing, causes airway surface dehydration and impaired mucus clearance, the team investigated the effect of promoting hydration with inhaled hypertonic saline.

For the study, the researchers recruited 41 children, between 2 and 6 years of age (mean 31.9 months), seen in the emergency department with moderate-to-severe acute wheezing. After an initial albuterol inhalation, they were assigned to receive either hypertonic saline 5% or normal saline, both along with further albuterol inhalation, twice at 20-minute intervals.

The admission rate was 62.2% in the hypertonic saline group compared with 92.0% in the normal saline group, the authors report. Furthermore, the median lengths of stay in the two groups were 2 days versus 3 days, respectively.

Discussing the results, Dr. Mandelberg and colleagues note that the admission rate was relatively high in this study because children with milder wheezing episodes were not recruited. “Thus,” they advise, “generalization of our conclusions to milder cases should be taken with caution until tested in a blinded randomized trial in ambulatory populations.”


Hypertonic Saline and Acute Wheezing in Preschool Children

Pediatrics 2012;129:e1397–e1403.