A randomized trial of nebulized 3% hypertonic saline with salbutamol in the treatment of acute bronchiolitis in hospitalized infants

Pediatr Pulmonol. 2016 Apr;51(4):418-25. doi: 10.1002/ppul.23306. Epub 2015 Sep 3.


Objective: Acute bronchiolitis is a common disorder of infants that often results in hospitalization. Apart from supportive care, no therapy has been shown to influence the course of the disease, except for a possible effect of nebulized hypertonic saline (HS). To determine whether this does have beneficial effects on length of stay in hospital or on severity scores, we undertook a double-blind, randomized, controlled trial in a pediatric department of a Portuguese hospital.

Methods: Previously healthy infants, younger than 12 months, hospitalized with mild-to-moderate acute viral bronchiolitis were randomized to receive either nebulized 3% (hypertonic, HS) or 0.9% (normal, NS) saline during their entire hospital stay. Primary endpoints were: length of hospital stay and severity scores on each day of hospitalization. Need for supplemental oxygen, further add-on medications and adverse effects were also analyzed.

Results: Sixty-eight patients completed the study (HS: 33; NS: 35). The median length of hospital stay did not differ between groups: HS: 5.6 ± 2.3 days; NS: 5.4 ± 2.1 days (P = 0.747). We found no difference between groups in severity scores from day 1 to day 4. There were no differences in need for supplemental oxygen or add-on medications. Patients in HS group had significantly more cough (46% vs. 20%, P = 0.025) and rhinorrhoe (58% vs. 31%, P = 0.30).

Conclusion: This study does not support the use of nebulized HS over NS in therapy of hospitalized children with mild-to-moderate acute viral bronchiolitis.

Keywords: Pneumonia; TB; asthma & early wheeze; evidence-based medicine & outcomes; viral.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Administration, Inhalation
  • Albuterol / administration & dosage*
  • Bronchiolitis / drug therapy*
  • Bronchiolitis / epidemiology
  • Bronchiolitis / physiopathology
  • Bronchodilator Agents / administration & dosage*
  • Child, Hospitalized
  • Cough / etiology*
  • Cough / prevention & control
  • Double-Blind Method
  • Female
  • Humans
  • Infant
  • Infant Health
  • Infant, Newborn
  • Length of Stay
  • Male
  • Nebulizers and Vaporizers
  • Portugal / epidemiology
  • Saline Solution, Hypertonic / administration & dosage*
  • Severity of Illness Index
  • Treatment Outcome


  • Bronchodilator Agents
  • Saline Solution, Hypertonic
  • Albuterol