Nebulised hypertonic saline? Maybe not, thanks

Key words: Nebulised hypertonic saline, bronchiolitis, acute viral wheezing, inhaled mucolytics

Nebulised hypertonic saline (HS) - usually 3% - has become part of paediatric practice for the management of respiratory diseases such as bronchiolitis and preschool wheezing. Acute bronchiolitis is a common disorder in infancy and often results in hospitalisation. No therapy has been shown to influence the course of the disease, other than supportive care. The quality of evidence of studies on positive effects of 3% nebulised saline is low to moderate and new analyses show no benefit. Prospective blinded studies concerning HS use in preschool children with acute viral wheezing are limited. Moreover, HS can induce bronchonconstriction and worsening of cough and should be used with caution especially in patients with bronchial hyperresponsiveness. Other drugs too are used for nebulisation (i.e. mucolytics) despite their unknown physical properties. The hypertonicity-induced bronchospasm can be prevented with the concurrent use of salbutamol.