Inhalation Of Hypertonic Saline Research Articles

Management of RSV Bronchiolitis in Outpatient Setting

AbstractSeasonal respiratory syncytial virus (RSV) lower respiratory infections (RSV-LRI) and bronchiolitis in children remain a high burden to medical facilities. Studies evaluating the practical approach in outpatient settings are scarce. We conducted a survey to provide an insight into management in pediatric offices in Germany. Invitations for participation in an online survey were sent to 623 providers of pediatric primary care via email. Recipients were randomly chosen from national databanks based on zip codes. The response rate was 16,2%, n=92 (14,7%) questionnaires were fully answered and analyzed. 93,5% (n=86) are board certified pediatricians. In outpatient setting, every second patient with suspected or confirmed RSV-LRI is presented three times or more. 40,7% of our participants refer less than 10% of all patients to hospital, 83,7% refer less than one third (<30%). 33,7% of all participants never perform virological testing in suspected cases of RSV-LRI. More than 50% of all participants prescribe bronchodilators, hypertonic saline inhalation is prescribed by 17,4%. Antibiotics are prescribed in less than 10% of all cases of RSV-LRI. About 3/4 ask for a clearer, more conclusive guideline regarding prophylaxis. The diagnostic approach varies significantly. Although not recommended in international guidelines, bronchodilators are still frequently used. Considering emerging options for passive immunization, broader inclusion criteria into immunization regimes are requested by the participants. More conclusive guidelines and recommendations could further improve the management of outpatient RSV-LRI in children.

Hypertonic saline inhalation therapy among patients with moderate asthma and functional dyspepsia commorbidity

Aim: Dry powder hypertonic saline inhalation use possibilities evaluation in moderate asthma and functional dyspepsia patients. Materials and Methods: 68 moderate asthma and functional dyspepsia patients were examined and treated according to the standard protocols, serum and erythrocytes membrane fatty acid levels were evaluated. The groups of patients with (n=35) and without (n=33) additional dry powder hypertonic saline inhalation use were compared after 1 month. Results: After additional use of dry powder hypertonic saline inhalations vs only standard treatment the rate of well controlled asthma was 3 fold higher with significantly higher FEV1. We also observed positive dynamics of serum arachidonic and docosahexaenoic acids levels indicating resolution of inflammatory reaction with erythrocytes membranes linoleic acid level normalization (source of antiinflammatory cytokines synthesis) among patients with dry powder hypertonic saline inhalation use vs without it. Among patients who used only standard therapy compared to the control group, the erythrocytes membrane linoleic acid level remained decreased with high serum arachidonic and docosahexaenoic acids levels. Follow-up results (after 1 year) showed a significant decrease in exacerbations frequency among patients who underwent dry powder hypertonic saline inhalation vs only the standard treatment. Conclusions: Among moderate asthma patients with functional dyspepsia use of dry powder hypertonic saline inhalation therapy additionally to the standard treatment allows to improve not only clinical and functional parameters but serum and erythrocytes membranes fatty acids spectrum as well leading to the systemic inflammatory reaction reduction and exacerbations prevention in remote period.

Nebulised 3% hypertonic saline versus 0.9% saline for treating patients hospitalised with acute bronchiolitis: protocol for a randomised, double-blind, multicentre trial

IntroductionBronchiolitis is an acute viral infection of the lower respiratory tract. It is most commonly caused by respiratory syncytial virus. Being a common reason for hospitalisation, it affects 13–17% of...

In Vitro Effect of Combined Hypertonic Saline and Salbutamol on Ciliary Beating Frequency and Mucociliary Transport in Human Nasal Epithelial Cells of Healthy Volunteers and Patients with Cystic Fibrosis.

Background: Inhalation of hypertonic saline (HS) is standard of care in patients with cystic fibrosis (CF). However, it is unclear if adding salbutamol has-besides bronchodilation-further benefits, for example, on the mucociliary clearance. We assessed this in vitro by measuring the ciliary beating frequency (CBF) and the mucociliary transport rate (MCT) in nasal epithelial cells (NECs) of healthy volunteers and patients with CF. Aims: To investigate the effect of HS, salbutamol, and its combination on (muco)ciliary activity of NECs in vitro, and to assess potential differences between healthy controls and patients with CF. Methods: NECs obtained from 10 healthy volunteers and 5 patients with CF were differentiated at the air-liquid interface and aerosolized with 0.9% isotonic saline ([IS] control), 6% HS, 0.06% salbutamol, or combined HS and salbutamol. CBF and MCT were monitored over 48-72 hours. Results: In NECs of healthy controls, the absolute CBF increase was comparable for all substances, but CBF dynamics were different: HS increased CBF slowly and its effect lasted for an extended period, salbutamol and IS increased CBF rapidly and the effect subsided similarly fast, and HS and salbutamol resulted in a rapid and long-lasting CBF increase. Results for CF cells were comparable, but less pronounced. Similar to CBF, MCT increased after the application of all the tested substances. Conclusion: CBF and MCT of NECs of healthy participants and CBF of patients with CF increased upon treatment with aerosolized IS, HS, salbutamol, or HS and salbutamol, showing a relevant effect for all tested substances. The difference in the CBF dynamics can be explained by the fact that the properties of the mucus are changed differently by different saline concentrations.

Twenty-one-year follow-up revealed guideline-concordant and non-concordant trends in intensive care of bronchiolitis

To evaluate the management of bronchiolitis in the paediatric intensive care unit (PICU) before and after publication of the national bronchiolitis guidelines in June 2015. All infants treated between 2016–2020 for bronchiolitis in the PICU of Tampere University Hospital at < 12 months of age were included. The data were retrospectively collected from electronic patient records. The current results reflecting the post-guideline era were compared with previously published results for the pre-guideline 2000–2015 period. These two studies used identical protocols. Forty-six infants treated in the PICU were included. During the post-guideline era, inhaled adrenaline was given to 26 (57%), salbutamol to 7 (15%), and hypertonic saline inhalations to 35 (75%) patients. Forty-three patients (94%) received high-flow oxygen therapy (HFOT). Seventeen patients (37%) were treated with nasal continuous positive airway pressure (CPAP) and 4 (9%) with mechanical ventilation.Conclusion: When post-guideline years were compared with pre-guideline years, the use of bronchodilators decreased in agreement, but the use of inhaled saline increased in disagreement with the guidelines. The use of respiratory support increased, evidently because of an introduction of the non-invasive HFOT treatment modality.What is Known:• Oxygen supplementation and respiratory support, when needed, are the cornerstones of bronchiolitis treatment.• Medicines are frequently given to infants with bronchiolitis, especially if intensive care is needed, although evidence of their effectiveness is lacking.What is New:• Nearly all (94%) infants who needed intensive care were treated with HFOT and 37% with nasal CPAP, and finally, only 9% were intubated, which reflects the effectiveness of non-invasive techniques.• When pre- and post-guideline eras were compared, use of racemic adrenaline decreased from 84 to 57%, but use of hypertonic saline increased up to 75%, which disagrees with the current guidelines.

Retracted: Nursing Progress of Hypertonic Saline Inhalation in the Treatment of Infantile Bronchitis Based on Image Enhancement

Retracted: Nursing Progress of Hypertonic Saline Inhalation in the Treatment of Infantile Bronchitis Based on Image Enhancement

Nasal epithelial cell culture fluorescence recovery after photobleaching predicts cystic fibrosis therapeutic response.

Human nasal epithelial (HNE) cells can be sampled noninvasively and cultured to provide a model of the airway epithelium that reflects cystic fibrosis (CF) pathophysiology. We hypothesised that in vitro measures of HNE cell physiology would correlate directly with in vivo measures of lung physiology and therapeutic response, providing a framework for using HNE cells for therapeutic development and precision medicine. We sampled nasal cells from participants with CF (CF group, n=26), healthy controls (HC group, n=14) and single CF transmembrane conductance regulator (CFTR) mutation carrier parents of the CF group (CR group, n=16). Participants underwent lung physiology and sweat chloride testing, and nuclear imaging-based measurement of mucociliary clearance (MCC) and small-molecule absorption (ABS). CF participants completed a second imaging day that included hypertonic saline (HS) inhalation to assess therapeutic response in terms of MCC. HNE measurements included Ussing chamber electrophysiology, small-molecule and liquid absorption rates, and particle diffusion rates through the HNE airway surface liquid (ASL) measured using fluorescence recovery after photobleaching (FRAP). Long FRAP diffusion times were associated with increased MCC response to HS in CF. This implies a strong relationship between inherent factors affecting ASL mucin concentration and therapeutic response to a hydrating therapy. MCC decreased with age in the CR group, which had a larger range of ages than the other two groups. Likely this indicates a general age-related effect that may be accentuated in this group. Measures of lung ABS correlated with sweat chloride in both the HC and CF groups, indicating that CFTR function drives this measure of paracellular small-molecule probe absorption. Our results demonstrate the utility of HNE cultures for assessing therapeutic response for hydrating therapies. In vitro measurements of FRAP were particularly useful for predicting response and for characterising important properties of ASL mucus that were ultimately reflected in lung physiology.

YIELD OF INDUCED SPUTUM IN CLINICALLY DIAGNOSED PULMONARY TUBERCULOSIS

Background:- Direct sputum smear examination is used as a basic diagnostic tool in the diagnosis of pulmonary tuberculosis. But difficulty in obtaining adequate sputum is the main cause of failure of bacteriological diagnosis. Alternative methods of obtaining sputum specimens are frequently needed in those patients with clinicoradiological suspicion of TB who are unable to expectorate or are smear negative. Aim:- To assess the yield of smear positivity of induced sputum (SI) with hypertonic saline nebulisation, broncho-alveolar lavage fluid and Rifampicin resistance in clinically diagnosed pulmonary TB who have no/inadequate sputum. Materials and Methods:- In the present cross-sectional observational study, we analysed the smear positivity of AFB in induced sputum of patients at Veer Surendra Sai Institute of Medical Science &amp; Research, Burla, Odisha, India, from November 2018 to October 2020. A total of 100 patients with clinically diagnosed pulmonary TB who were unable to produce adequate sputum fulfilling inclusion criteria were included in the study. 10 ml of 3% hypertonic saline was injected into the nebulizer reservoir device. The assembly was connected to the jet nebulizer. The patients were instructed to inhale and exhale the mist of the nebulized solution through the mouth piece only. The inhalation of hypertonic saline was interrupted every 5 min, so that the patient could expectorate the sputum into a clean sterile sputum container. The sputum samples were stained with auramin-rhodamin stain and examined for AFB, also same samples were subjected for CBNAAT(cartridge based nucleic acid amplification test). Selected sputum induction(SI) CBNAAT negative patients are also underwent bronchoscopy and BAL fluid was subjected for CBNAAT. Results:- Out of 100 clinically diagnosed tuberculosis patients, 49% of cases had only infiltration, 45% cases had consolidation,17% had infiltration with fibrosis,16% cases with cavitary lesions and 6% had miliary lesions in chest X -ray. 17(17%) cases became induced sputum smear positive, 30(30%) cases became induced sputum CBNAAT positive. All induced sputum CBNAAT positive cases were rifampicin sensitive. No rifampicin resistance was detected. Out of 70 patients with SI CBNAAT negative, 21 patients with highly clinico radiological suspicion underwent bronchoscopy and 4(19%) patients become post bronchoscopy sputum AFB positive. Out 21 patients 8(38%) patients become BAL CBNAAT positive and all are rifampicine sensitive. Conclusion:- Induced sputum and BAL fluid are better alternative methods for diagnosis in patients with clinico-radiological suspicion of TB who are unable to expectorate or are smear negative and no rifampicin resistant cases were detected throughout this study.

The Differences Between RSV and no RSV Acute Bronchiolitis in Hospitalized Infants: A Cross-Sectional Study.

To identify the differences between the RSV and non-RSV bronchiolitis in hospitalized infants in a Greek tertiary pediatric unit and the possible risk factors related to severe forms of the illness. We performed a retrospective cross-sectional data analysis by reviewing medical records of patients that were hospitalized for acute bronchiolitis from 2012 to 2019. The patients with RSV bronchiolitis were found to require antibiotic treatment, IV fluids, adrenaline, and hypertonic saline inhalations more frequently than the non-RSV patients. They also required prolonged hospitalization, especially those that were admitted to PICU, and received oxygen therapy for longer periods. We searched risk factors for severe forms of the disease according to the need for admission to PICU, the supplemental oxygen and the extended length of hospital stay, concurrently. The patients with RSV bronchiolitis developed more severe illness in comparison with patients with bronchiolitis due to other respiratory viruses.

Hypertonic saline in the treatment of patients with cystic fibrosis in Russian Federation

Introduction. Mucolytic therapy is basic in the treatment of patients with cystic fibrosis (CF). Currently, inhalation of hypertonic saline (HS) of NaCl is recommended for the treatment of CF patients.The aim of the study was to investigate the experience of the use of HS NaCl for inhalations CF patients in the Russian Federation.Material and methods. To estimate the use of HS NaCl, data of national registers for 2011–2019 were used. Pharmacoeconomic analysis of “HS 7% NaCl + 0.1% sodium hyaluronate”, presented in the Russian market, carried out according to the cost estimate for the course of therapy based on the cost from the site of the unified information system in the sphere of procurement.Results. From 2011 to 2019, an increase in the number of patients receiving the inhalation of a HS is observed. 2011 –8.7% of patients with CF, by 2019 – in 71.5% of CF patients. In 25 regions of the Russian Federation more than 80% of CF patients used HS NaCl. The cost analysis of Russian-made medicinal products for human use containing 7% HS and 0.1% sodium hyaluronate solution, and foreign-made products of similar composition showed that the annual cost of therapy with Russian-made products was 2.15 times lower than that with the foreign-made products. As for the medicinal product mannitol, the annual cost of therapy with a foreign-made product is 8.1 times higher than the cost of a Russian-made product.Conclusions. The clinical practice of treating patients with CF has accumulated positive use of HS in inhalations, the use of which has increased significantly since 2011. Medical products 3 and 7% HS with a 0.1% solution of sodium hyaluronate are prescribed from the moment of diagnosis and have advantages over the HS pharmacy production over portability and ease of use. The use of the “7% HS with a 0.1% solution of sodium hyaluronate” is mainly determined by the financial accessibility.

Safety of airway clearance combined with bronchodilator and hypertonic saline in non-hospitalized infants with acute bronchiolitis

Background: Acute viral bronchiolitis (AVB) is associated with significant morbidity and no study has addressed the safety of airway clearance techniques (ACT) for non-hospitalized infants. This study aimed to evaluate the safety of the use of ACT combined with bronchodilator and hypertonic saline in non-hospitalized children with the first episode of AVB. Methods: A quasi-experimental study of infants aged 2–12 months, with a clinical diagnosis of AVB (mild to moderate), was performed. The Wang score, breathing frequency, oxygen saturation (SpO2), heart rate (HR), and the presence of adverse events were evaluated before, 10 and 20 min after the application of a protocol including ACT (nasal irrigation, prolonged slow expiration, and provoked cough), bronchodilator and hypertonic saline inhalation. A total of 265 infants, mean age 6.86±3.01 months, were included. Results: A reduction (p<0.001) in the Wang score and in the breathing frequency as well as an increase in SpO2 were found. There was also a transient HR increment at 10 min followed by a reduction at 20 min (p<0.05). The proportion of patients presenting with chest retraction and wheezing decreased (p<0.001) after treatment. Most of the children (88.3%) did not experience adverse events. A post-treatment increment (p<0.001) of patients classified as having normal values, as well as a decrease in those with mild and moderate AVB, was found for the Wang score levels. Conclusion: The use of ACT combined with bronchodilator and hypertonic saline was safe, immediately after treatment, for non-hospitalized children with mild to moderate AVB. No clinically important deterioration or adverse events were identified in the follow-up period.

Treatment of Bronchiolitis Using Nebulized Hypertonic Saline in Asthma-Prone and Non-Asthma-Prone Patients

Background: In bronchiolitis, children under the age of two experience cough, dyspnea and wheezing, following a viral upper respiratory infection. Frequently recurrent bronchiolitis in infants with atopic background is the best example of asthma-prone viral-induced wheeze. In bronchiolitis management, inhaled hypertonic saline is the subject of debate among pediatricians and researchers. Nebulized hypertonic saline acts by increasing fluidity of airway surface liquid. Bronchospasm is a theoretical risk for inhaled hypertonic saline when used without adjunctive bronchodilators. Objective: To compare the response to nebulized hypertonic saline plus B 2 agonists, with nebulized isotonic saline plus B 2 agonists, in asthma-prone and non-asthma-prone bronchiolitis patients. Patients and methods: This study was a randomized double blind controlled trial, which was carried out at Pulmonology Unit, Pediatric Department, Zagazig University Children Hospital. The study was conducted on 104 infants with acute viral bronchiolitis of mild to moderate severity. They were divided into two groups 52 in each group. Group 1: Asthma-prone patients and group 2, which included non-asthma-prone patients. Patients were randomly assigned to receive inhalation of 0.3 mg/kg salbutamol added to 5 ml of either normal saline 0.9% or hypertonic saline 3%. Within each group the number of patients receiving hypertonic or isotonic saline inhalation was equal to 26. Results: Nebulized hypertonic saline salbutamol mixture resulted in better improvement of the studied asthma-prone and non-asthma prone bronchiolitis patients. Hypertonic saline decreased case severity and days of hospital stay. Conclusion: Nebulized hypertonic saline shortened the days of hospital admission and improved the respiratory distress in mild to moderate bronchiolitis. Nebulized hypertonic saline is equally effective in asthma-prone and non-asthma-prone patients and its beneficial effect outweighs its theoretical broncho-constrictive effect.

A randomized controlled trial of nebulized epinephrine versus nebulized hypertonic saline in infants with acute bronchiolitis

Background: Acute Bronchiolitis is an infection of the lower respiratory tract, most frequently caused by the respiratory syncytial virus. It is one of the most common cause of hospital admission for respiratory tract illnesses in infants. This is a double blinded randomized controlled trial, conducted to compare the therapeutic efficacy of nebulized epinephrine versus nebulized hypertonic saline in infants with acute bronchiolitis.Methods: It was a double blinded randomized controlled trial conducted over a period of 18 months (January 2019-June 2020) in infants aged 2 months to 1 year diagnosed with acute bronchiolitis. All eligible patients were randomly assigned to one of two groups: Group I received inhalation of Epinephrine; Group II received inhalation of Hypertonic (3%) Saline. Patients in each group received four treatments on each day of hospitalization, delivered at 6 hourly intervals. Monitoring parameters for improvement or worsening of the condition were measured and recorded on admission and then at 24 hourly intervals using the clinical score described by Wang, et al for the first three days of treatment.Results: Among the infants treated with hypertonic saline, there was a significant decrease in the post inhalation respiratory score on day 2 and day 3 as compared to the infants treated with epinephrine. There was a significant difference in duration of hospitalization between the two groups as duration of hospitalization in infants was less in hypertonic saline group as compared to the epinephrine group. Hypertonic saline also showed significantly lesser side effects post inhalation when compared to epinephrine. The difference was statistically significant with p&lt;0.0001.Conclusions: The study concluded that the use of nebulized hypertonic saline in infants aged 2 months to 12 months, provides evidence for its role as an efficient treatment modality in the treatment of acute bronchiolitis. The study also found that nebulized epinephrine had more side effects associated with it.

The cost-effectiveness of hypertonic saline inhalations for infant bronchiolitis

BackgroundPharmacological treatment for bronchiolitis is primarily supportive because bronchodilators, steroids, and antibiotics, show little benefit. Clinical studies have suggested that nebulized 3% hypertonic solution is useful for infants with bronchiolitis. This study aims to evaluate the cost-effectiveness of the HS inhalations in infant bronchiolitis in a tropical country.MethodsDecision tree analysis was used to calculate the expected costs and QALYs. All cost and use of resources were collected directly from medical invoices of 193 patient hospitalized with diagnosis of bronchiolitis in tertiary centers, of Rionegro, Colombia. The utility values applied to QALYs calculations were collected from the literature. The economic analysis was carried out from a societal perspective.ResultsThe model showed that nebulized 3% hypertonic solution, was associated with lower total cost than controls (US $200vs US $240 average cost per patient), and higher QALYs (0.92 vs 0.91 average per patient); showing dominance. A position of dominance negates the need to calculate an incremental cost-effectiveness ratio.ConclusionThe nebulized 3% hypertonic solution was cost-effective in the inpatient treatment of infant bronchiolitis. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other tropical countries.

Timing of hypertonic saline inhalation for cystic fibrosis.

Inhalation of hypertonic saline improves sputum rheology, accelerates mucociliary clearance and improves clinical outcomes of people with cystic fibrosis. This is an update of a previously published Cochrane Review. To determine whether the timing of hypertonic saline inhalation (in relation to airway clearance techniques or in relation to time of day) has an impact on its clinical efficacy in people with cystic fibrosis. We identified relevant randomised and quasi-randomised controlled trials from the Cochrane Cystic Fibrosis Trials Register, the Physiotherapy Evidence Database (PEDro), and international cystic fibrosis conference proceedings. Date of the last search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register: 28 February 2019. Any trial of hypertonic saline in people with cystic fibrosis where timing of inhalation was the randomised element in the study protocol with either: inhalation up to six hours before airway clearance techniques compared to inhalation during airway clearance techniques compared to inhalation up to six hours after airway clearance techniques; or morning compared to evening inhalation with any definition provided by the author. Both authors independently assessed the trials identified by the search for potential inclusion in the review. The certainty of the evidence was assessed using GRADE. The searches identified 104 trial reports which represented 51 trials, of which three cross-over trials (providing data on 77 participants) met our inclusion criteria. We present three comparisons: inhalation before versus during airway clearance techniques; inhalation before versus after airway clearance techniques; and inhalation during versus after airway clearance techniques. One trial (50 participants), given its three-arm design, was eligible for all three comparisons. No trials compared morning versus evening inhalation of hypertonic saline. The evidence from the three trials was judged to be of low quality downgraded for limitations (high risk of bias due to blinding) and indirectness (all participants are adults, and therefore not applicable to children). Intervention periods ranged from one treatment to three treatments in one day. There were no clinically important differences between the timing regimens of inhaling hypertonic saline before, during or after airway clearance techniques in the mean amount of improvement in lung function or symptom scores (77 participants), with the between-group comparisons being non-significant (low-certainty evidence). While there may be little or no difference in the rating of satisfaction when hypertonic saline was inhaled before versus during the airway clearance techniques (64 participants) (with the 95% confidence interval including the possibility of both a higher and lower rating of satisfaction), satisfaction may be lower on a 100-mm scale when inhaled after the airway clearance techniques compared to before: mean difference (MD) 20.38 mm (95% confidence interval (CI) 12.10 to 28.66) and when compared to during the techniques, MD 14.80 mm (95% CI 5.70 to 23.90). Perceived effectiveness showed similar results: little or no difference for inhalation before versus during airway clearance techniques (64 participants); may be lower when inhaled after the airway clearance techniques compared to before, MD 10.62 (95% CI 2.54 to 18.70); and also when compared to during the techniques, MD 15.60 (95% CI 7.55 to 23.65). There were no quality of life or adverse events reported in any of the trials. Timing of hypertonic saline inhalation makes little or no difference to lung function (low-certainty evidence). However, inhaling hypertonic saline before or during airway clearance techniques may maximise perceived efficacy and satisfaction. The long-term efficacy of hypertonic saline has only been established for twice-daily inhalations; however, if only one dose per day is tolerated, the time of day at which it is inhaled could be based on convenience or tolerability until evidence comparing these regimens is available. The identified trials were all of very short intervention periods, so longer-term research could be conducted to establish the effects arising from regular use, which would incorporate the influence of changes in adherence with long-term use, as well as generating data on any adverse effects that occur with long-term use.

Is Induced Sputum A Useful Noninvasive Tool in the Diagnosis of Pulmonary Sarcoidosis?

In patients with pulmonary sarcoidosis, the provocation of sputum expectoration through the inhalation of hypertonic saline has been investigated as an alternative diagnostic tool for invasive procedures. We aimed to assess the diagnostic value of induced sputum (IS) by observing its cell distribution in patients with a confirmed histopathological diagnosis of sarcoidosis. In this prospective, cross-sectional study, we compared the IS results of 20 patients with a histopathologically confirmed pulmonary sarcoidosis diagnosis and 24 healthy volunteers. The percentages of macrophages, lymphocytes, neutrophils, and eosinophils in IS and the CD4/CD8 ratio were compared. The percentage of lymphocytes in IS was significantly higher in the pulmonary sarcoidosis patients compared to the control group (41.6% vs 8.9%, p<0.001). There were no significant differences in the other IS cell percentages and CD4+/CD8+ ratio between the groups. Sputum induction was well tolerated. Sputum induced by the inhalation of hypertonic saline is a safe, inexpensive, less invasive, and easily repeated method and can be a valuable alternative to other invasive methods in the diagnosis of pulmonary sarcoidosis.

Hypertonic Saline Inhalation in Acute Bronchiolitis

Hypertonic Saline Inhalation in Acute Bronchiolitis

Acute effects of hypertonic saline inhalation on nitric oxide pulmonary diffusing capacity in healthy adults

We investigated acute effects of inhalation of hypertonic saline solution (HSS) and oxygen (O2, control exposure) on pulmonary diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO). In a randomized crossover study, 20 healthy, non-smoking subjects were allocated to short-term inhalation of HSS or O2. Spirometry [(forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC)] and combined single-breath DLNO-DLCO measurements were performed before and immediately after inhalation of either HSS or O2. Percent changes were presented as median values (interquartile range). After HSS inhalation, DLNO, FEV1 and FVC were decreased by −3.0% (−7.3, 0.5), −3.1% (−4.2, −1.6) and −1.2% (−3.3, 0.6), respectively (all P < 0.05), without significant effect on DLCO. No changes in spirometry and diffusing capacity were observed following O2 inhalation. Acute inhalation of HSS causes a slight decrease in membrane conductance, probably as a result of fluid imbalance at the alveolar surface and interstitial fluid accumulation, both of which could impair gas exchange.

The change in management of bronchiolitis in the intensive care unit between 2000 and 2015.

This case-control study evaluated interventions for bronchiolitis in relation to time in the pediatric intensive care unit (PICU) during a 16-year surveillance period. Together, 105 infants aged < 12months were treated for bronchiolitis in the PICU, and for them, we selected 210 controls admitted for bronchiolitis closest to cases. We collected data on treatments in the PICU, at the ward and in the emergency department for three periods: years 2000-2005, 2006-2010, and 2011-2015. Median hospital length of stay for PICU patients were 7days (interquartile range 5-12), 5days (4-8) and 8days (4-12.5, p = 0.127), respectively. By time, the use of inhaled beta-agonist (68 vs. 44 vs. 38%, p = 0.019) and systemic corticosteroids (29 vs. 15 vs. 5%, p = 0.019) decreased, but that of racemic adrenaline (59 vs. 78 vs. 84%, p = 0.035) and hypertonic saline (0 vs. 0 vs. 54%, p < 0.001) inhalations increased in the PICU. Similar changes were seen at the ward. In the PICU, non-invasive ventilation therapies increased significantly, but intubation rates did not decline.Conclusion: Beta-agonists and systemic corticosteroids were used less by time in intensive care for infant bronchiolitis, but the use of hypertonic saline and racemic adrenaline increased, though their effectiveness has been questioned. What is Known: • Until now, studies have shown which treatments do not work in bronchiolitis, and so, there is no consensus how infants with bronchiolitis should be treated. In particular, there is no consensus on different interventions in intensive care for bronchiolitis. What is New: • During 2000-2015, treatments with inhaled beta-agonists and systemic corticosteroids decreased but treatments with racemic adrenaline and hypertonic saline inhalations increased in intensive care for bronchiolitis. Similar changes were seen at the ward. Though non-invasive ventilation therapies increased, the intubation rate did not decline.

The cost-effectiveness of hypertonic saline inhalations for infant bronchiolitis: a decision analysis

This study evaluated the cost-effectiveness of hypertonic saline (HS) inhalations for infant bronchiolitis, compared to normal saline inhalations or standard treatment without inhalations as controls. The decision tree in the decision analysis was used to calculate the expected costs. Actual cost data were obtained from our retrospective case-control study on bronchiolitis treatment. The effectiveness of treatment, based on the hospitalization rate of those admitted to the emergency department and the length of stay (LOS) of those who were hospitalized, was collected from previous studies. For the effectiveness estimations, we made a meta-analysis summarizing the results of the meta-analysis of the Cochrane review in 2013 and the results of 10 studies published after it. The mean hospitalization rate was 24.7% in the HS inhalation group and 32.6% in the control group [risk ratio: 0.80, 95% confidence interval (CI) 0.67-0.96] and the mean LOS was 3.736 (HS group) and 4.292 (controls) days (mean difference: - 0.55days, 95% CI - 0.96 to - 0.15), respectively. The expected costs per patient, when both inpatients and outpatients were included, were €816 ($1111) in the HS inhalation group and €962 ($1310) in the control group. The expected costs per hospitalization, when only inpatients were included, were €2600 ($3540) in the HS inhalation group and €2890 ($3935) in the control group. HS inhalations slightly reduced the expected hospitalization costs of infant bronchiolitis. However, the low effectiveness, rather than the cost, is the factor that will limit the use of HS inhalations in infant bronchiolitis.