South, M. Hypertonic saline in bronchiolitis, Don't Forget the Bubbles, 2014. Available at:
Nebulised hypertonic saline ineffective in infants hospitalised with acute bronchiolitis.
Everard ML, Hind D, Ugonna K, Freeman J, Bradburn M, Cooper CL, Cross E, Maguire C, Cantrill H, Alexander J, McNamara PS. SABRE: a multicentre randomised control trial of nebulised hypertonic saline in infants hospitalised with acute bronchiolitis. Thorax. 2014 Dec 1;69(12):1105-12.
Nebulised hypertonic saline (HS) is used routinely to treat bronchiolitis in some overseas centres. It is not widely used in Australia to my knowledge.
Several early studies suggested that HS could shorten the duration of illness and hospitalisation and the 2013 Cochrane review concluded with a recommendation to use this therapy in bronchiolitis to reduce length of hospital stay.
This new study, published today in Thorax, provides important new evidence. It is the largest RCT to date of HS therapy and it found no benefit.
This study has several practical differences that make it more likely to represent the true effect of HS in clinical practice. The case definition of bronchiolitis was more robust and the choice of control therapy (usual care) was better and more pragmatic than other studies that used nebulised normal saline or water as controls. They also didn’t use other what I think of as ineffective therapies such as nebulised salbutamol or adrenaline.
It joins a number of smaller recent studies which also point to HS being an ineffective therapy. One more very large study is currently in the analysis phase but in the meantime I conclude that HS is not an effective therapy for babies with bronchiolitis.