Nebulized normal saline improves respiratory symptoms in acute bronchiolitis: JAMA
USA: Nebulized normal saline (NS) may be an active treatment for acute viral bronchiolitis, according to a recent review published in the journal JAMA Pediatrics. Nebulized NS is generally used as a placebo in clinical trials evaluating therapies for acute viral bronchiolitis.
In therapeutic trials for acute viral bronchiolitis, consistent clinical improvement in groups that received nebulized normal saline as placebo raised the question of whether nebulized NS acts as a treatment rather than a placebo.
Samantha A. House, Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, and colleagues undertook a systematic review and meta-analysis of randomized clinical trials in acute viral bronchiolitis using nebulized [normal saline] with 2 objectives: to compare nebulized [normal saline] with other forms of placebo (eg, non-nebulized placebo or sham nebulization) and to estimate the association of nebulized [normal saline] with short-term physiologic measures of respiratory status in randomized clinical trials in which it was used as the placebo.
The analysis included a total of 29 studies (n=1583).
Key findings of the study include:
- Standardized mean differences in respiratory scores for nebulized NS vs another placebo (3 studies) favoured nebulized NS by −0.9 points at 60 minutes after treatment.
- There were no differences in respiratory rate or oxygen saturation comparing nebulized NS with other placebo.
- The standardized mean difference in a respiratory score (25 studies) after nebulized NS was −0.7.
- The weighted mean difference in respiratory scores using a consistent scale (13 studies) after nebulized NS was −1.6 points.
- The weighted mean difference in respiratory rate (17 studies) after nebulized NS was −5.5 breaths per minute.
- The weighted mean difference in oxygen saturation (23 studies) after nebulized NS was −0.4%.
"Nebulized NS may be an active treatment for acute viral bronchiolitis. Further evaluation should occur to establish whether it is a true placebo," concluded the authors.
The study, "Evaluating the Placebo Status of Nebulized Normal Saline in Patients With Acute Viral Bronchiolitis: A Systematic Review and Meta-analysis," is published in the journal JAMA Pediatrics.
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