A previous study at this hospital showed a similar subjective response to nebulized saline given at 7 am but the previous study also reported an improvement in FEV1 and PEF [ 13 ]. Patients in the previous study received nebulized saline on awakening, prior to their first bronchodilator treatment of he day. In these circumstances, it is likely that the nebulized saline assisted the expectoration of copious overnight secretions in the airways with some subsequent improvement in airflow.
Patients in the present study were treated at about mid-day, having had bronchodilator therapy on awakening. It is therefore not surprising that the beneficial effects of nebulized saline were more modest in the present study. However, this study lends support to the common clinical practice of allowing patients with COPD to have nebulized saline "as required" as a supplement to regular nebulized bronchodilator therapy.
This may assists sputum expectoration and relieve breathlessness without the side-effects that would occur if additional beta agonist treatment were given.
This study is in agreement with previous studies which have shown no bronchodilator effect or a small bronchoconstrictor effect when nebulized saline is given to patients with COPD [ 3 ]. This justifies the continuing use of nebulized saline as a placebo treatment in clinical trials of bronchodilator therapy which measure rise in FEV1 or PEF as the primary outcome measure.
However, as nebulized saline has non-bronchodilator therapeutic effects, it cannot be used as an inert placebo treatment in clinical studies where breathlessness or quality of life are to be measured. For example, Jenkins et al concluded that nebulized treatment had a strong placebo effect because patients expressed a preference for nebulized treatment even though the same bronchodilator effect could be achieved for most of their patients when nebulized saline was given with active bronchodilator therapy from a MDI device [ 10 ].
It is likely that many of these patients experienced a non-bronchodilator therapeutic benefit such as enhanced mucus clearance during nebulized saline therapy. It would be possible to co-administer nebulized saline with MDI bronchodilator therapy as an alternative to nebulized bronchodilator therapy for some patients with COPD who report difficulties with mucus clearance.
However, this would be more inconvenient than nebulized bronchodilator therapy and at least as expensive. For future clinical trials it would be possible to have two control groups, one receiving nebulized saline using an efficient system and one group using an inefficient system such as that used in the present study. This would allow investigators to assess whether nebulized saline had any therapeutic effect on their patients and it would also assess the true placebo response rate. British and European nebulizer guidelines state that most patients with airflow obstruction should be treated with hand-held devices unless they have demonstrated clear additional benefit from the use of nebulized treatment in carefully monitored domiciliary studies [ 12 , 14 ].
The present study supports these recommendations, especially the provision that some patients may be commenced on nebulized treatment on the basis of substantial subjective benefit even if an additional bronchodilator response cannot be demonstrated. This study also supports the present practice of many physiotherapists and doctors who use nebulized isotonic saline to assist sputum clearance for patients with COPD who have difficulty in expectorating sputum. Paediatr Pulmonol.
Aust NZ J Med. Respir Med. Eur Respir J. Clin Exp Allergy. Respiratory Medicine. Article PubMed Google Scholar. European Respiratory Journal. O'Driscoll BR: Nebulizers for chronic obstructive pulmonary disease. Download references. You can also search for this author in PubMed Google Scholar.
Saline solution in nebulizer to help move mucous Return to previous page. Ferenc 5 years ago. Edit Remove Accept Unaccept. Saline solution in nebulizer to help move mucous. Answer View More. Review question Is hypertonic saline solution via nebuliser effective and safe for the treatment of infants with acute bronchiolitis, compared to normal saline solution?
Background Acute bronchiolitis is the most common lower respiratory tract infection in children aged up to two years. This is an update of a review previously published in , , and Key results Nebulised hypertonic saline may reduce hospital stay by 10 hours in comparison to normal saline for infants admitted with acute bronchiolitis. Quality of evidence The quality of the evidence was low to moderate: there were inconsistencies in results among trials and risk of bias in some trials.
Authors' conclusions:. Search strategy:. Selection criteria:. Data collection and analysis:. Main results:. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials. Hospital de Gineco - Pediatria. Instituto Mexicano del Seguro Social. More Information. Nottingham, United Kingdom: University of Nottingham.
Effect of inhaled hypertonic saline on hospital admission rate in children with viral bronchiolitis: a randomized trial. Indian Pediatr. Epub Dec 5. Nebulized hypertonic-saline vs epinephrine for bronchiolitis; proof of concept study of cumulative sum CUSUM analysis. Epub Oct J Pediatr. Epub Jun Nebulized hypertonic saline treatment in hospitalized children with moderate to severe viral bronchiolitis. Clin Microbiol Infect. Epub Jul Arch Pediatr Adolesc Med. Pediatr Int. Epub Aug 7. Evaluation of an alternative chest physiotherapy method in infants with respiratory syncytial virus bronchiolitis.
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