By Dr. BPS Tyagi Inhalation of a solution of 5% hypertonic saline (HS) significantly shortens hospital length of stay and lowers admission rates in children presenting to the emergency department with an acute wheezing episode. HS is a pro–airway surface liquid hydration therapy.
Dorit Ater, MD, from Tel Aviv University in Israel, and colleagues published the results of their randomized controlled, double-blind study online May 21 in Pediatrics. This was the first study to examine HS treatment in preschool children (32 ± 17 months of age) with a wheezing episode.
The study included 41 children (age range, 1 – 6 years) who presented to the emergency department between January 2009 and January 2011. The authors excluded viral bronchiolitis cases, and only 1 patient was diagnosed with respiratory syncytial virus by polymerase chain reaction.
The children were given 1 albuterol treatment and then randomly assigned to receive either 4 mL of 5% HS (n = 16) or 4 mL of normal saline (NS; n = 25). Both groups were given 0.5 mL albuterol twice every 20 minutes in the emergency department and 4 times a day thereafter if hospitalized.
The primary outcome was length of stay, and the secondary outcomes were admission rate and clinical severity score.
The addition of HS inhalations to common practice treatment shortened length of stay by 33% (P = .027). The length of stay was 1 day shorter in the HS group (median, 2 days; range, 0 – 6 days) than the NS group (median, 3 days; range, 0 – 5 days).
The absolute risk for hospitalization was decreased by 30% (62.2% in the NS group and 92% in the HS group). Although the clinical severity score improved significantly in both groups, the difference between the 2 groups did not reach statistical significance (P = .1).
The authors note that the majority of the control group (92%) required hospitalization. This rate is higher than the rates previously reported by the hospital in 1997 and 1998. They also explain that children older than 4 or 5 years were underrepresented in the study.
HS acts on the airways by inducing an osmotic flow of water into the mucous layer. This rehydrates secretions and improves mucous rheology.