Nebulized 5% or 3% hypertonic or 0.9% saline for treating acute bronchiolitis in infants

J Pediatr. 2010 Oct;157(4):630-4, 634.e1. doi: 10.1016/j.jpeds.2010.04.074. Epub 2010 Jun 19.


Objective: To compare the efficacy and safety of 5%, 3%, and 0.9% saline solution for treating acute bronchiolitis in the prehospital setting.

Study design: This was a double-blind trial including consecutive infants aged <18 months treated in an urban urgent care setting. A total of 165 patients were randomized to receive nebulized 5%, 3%, or 0.9% (normal) saline with epinephrine every 4 hours. The primary efficacy outcome was bronchiolitis severity score improvement at 48 hours (chi2 analysis). Scores and oxygen saturation immediately before and after each treatment were recorded to assess safety.

Results: A total of 187 previously healthy infants (median age, 3.1 months) diagnosed with bronchiolitis were enrolled. Positivity for respiratory syncytial virus was similar in the 3 treatment groups (mean, 56%). At 48 hours, the mean severity score for the 5% saline group was 3.69+/-1.09, and that for the 0.9% saline group was 4.12+/-1.11 (P=.04; difference, 0.43, 95% confidence interval for the difference, 0.02-0.88). The mean severity score for the 3% saline group was intermediate at 4.00+/-1.22. Revisit rates after discharge were similar in the 3 treatment groups. No adverse reactions or other safety concerns were identified.

Conclusions: Nebulization with 5% hypertonic saline is safe, can be widely generalizable, and may be superior to current treatment for early outpatient treatment of bronchiolitis.

Trial registration: NCT01016249.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acute Disease
  • Administration, Inhalation
  • Ambulatory Care
  • Bronchiolitis / drug therapy*
  • Bronchiolitis / epidemiology*
  • Bronchiolitis / virology
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / therapeutic use*
  • Double-Blind Method
  • Female
  • Humans
  • Infant
  • Male
  • Nebulizers and Vaporizers
  • Respiratory Syncytial Virus Infections / complications
  • Respiratory Syncytial Virus Infections / drug therapy
  • Respiratory Syncytial Viruses / isolation & purification
  • Saline Solution, Hypertonic / administration & dosage
  • Saline Solution, Hypertonic / therapeutic use*


  • Bronchodilator Agents
  • Saline Solution, Hypertonic

Associated data