Treatment with nebulized hypertonic solution in children with acute bronchiolitis: “less is more”

Key words: Nebulized hypertonic solution, Acute bronchiolitis, Length of stay in hospital

Since 2013, all the published trials, without any exception, showed that treatment with nebulized hypertonic solution did not reduce the length of stay in hospital (LOS) of children with acute bronchiolitis. Trials published before 2013 were flawed by significant methodological weakness e.g. no uniform bronchiolitis definition, heterogeneity of interventions or clinical scoring and, above all, the inclusion of children older than 12 months. Nevertheless, considering all trials, the supposed reduction in the LOS is nearly of 11 hours only. Since 2013, only one trial, at high risk of patients’ selection bias, showed a benefit of this treatment to reduce the risk of hospitalization of these children. The most recent and better methodologically designed trials do not support the use of nebulized hypertonic solution in children with acute bronchiolitis. Therefore, available evidence does not allow to consider hypertonic solution potentially effective and well tolerated for acute bronchiolitis neither does justify its routinely use in clinical practice.