Nebulized Hypertonic Saline in Children with Acute Wheezing or Asthma Exacerbation: A Systematic Review and Meta-analysis

Abstract

Abstract Objective: The objective of this study was to evaluate the efficacy and safety of nebulized hypertonic in children with acute wheezing or asthma exacerbation. Methods: Systematic review and meta-analysis of randomized controlled trials (RCTs) with the application of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Relevant databases were searched till July 30, 2023. Results: Of 157 citations retrieved, two RCTs including 88 children were included in the review. A total of 38 children received hypertonic saline (HS) (5% in 16 children), and 63.6% (n = 56) were male. The RCTs included children with acute wheezing (one included acute viral wheezing) either the first episode or recurrent episodes. Compared to the control group, the nebulized HS group had a decrease in hospital stay of 1 day. The admission rate, discharge rate, and asthma severity score improved in the HS group. The evidence generated for the primary outcome (duration of hospital stay) was of “moderate certainty,” and for secondary outcomes, it varied from “very low to moderate certainty.” Conclusions: HS (3% or 5%) along with salbutamol decreased the duration of hospitalization and asthma severity score in children aged 6 months–6 years presenting with acute wheezing to the emergency department. The evidence generated was of “moderate certainty.” However, we need more data from high-quality RCTs with large sample sizes from diverse settings before any recommendation can be made. [PROSPERO registration number: CRD42022354696].