A Randomized Control Trial on the Comparative Efficacy of Hypertonic Saline Versus Adrenaline Nebulization in Acute Bronchiolitis
DOI:
https://doi.org/10.70749/ijbr.v3i7.2638Keywords:
Late neonatal sepsis, Urinary tract infection, Newborn infection, Frequency.Abstract
Background: Acute bronchiolitis is one of the main cause of lower respiratory illness in infants and children, producing airway blockage and hard breathing. Different nebulized medicines are used to reduce the symptoms, but the scientific proof is not uniform about how much hypertonic saline or adrenaline work better. Checking these treatments in local hospital condition is very important to find the most proper clinical method for managing the affected children. Objective: To compare the efficacy of nebulized hypertonic saline with adrenaline in improving clinical severity scores and reducing hospital stay in children with acute bronchiolitis. Study Design: Double-blind randomized controlled trial. Duration and Place of Study: The study was conducted from February 2025 to May 2025 in the Department of Pediatrics, CMH Nowshera. Methodology: A total of 62 children aged 1.5 months to 2 years with clinically diagnosed bronchiolitis were randomly assigned into two equal groups. Group A received nebulized adrenaline every six hours, while Group B received nebulized 3% hypertonic saline at the same interval. The Wood-Downes-Férres score was used to assess disease severity at baseline and 24 hours post-treatment. Oxygen requirement and total hospital stay were recorded. Results: The mean WDF score after 24 hours was significantly lower in the hypertonic saline group (3.77 ± 0.85) compared to the adrenaline group (4.65 ± 0.99; p < 0.001). The mean hospital stay was also shorter with hypertonic saline (2.65 ± 0.84 days) versus adrenaline (4.06 ± 1.41 days; p < 0.001). Oxygen requirement was reduced in the hypertonic saline group (6.5% vs 22.6%). Conclusion: Hypertonic saline nebulization is more effective than adrenaline in improving respiratory distress and reducing hospital stay among children with acute bronchiolitis.
Downloads
References
1. Tian J, Wang XY, Zhang LL, Liu MJ, Ai JH, Feng GS, et al. Clinical epidemiology and disease burden of bronchiolitis in hospitalized children in China: a national cross-sectional study. World J Pediatr. 2023;19(9):851-863.
https://doi.org/10.1007/s12519-023-00688-9
2. Florin TA, Plint AC, Zorc JJ. Viral bronchiolitis. Lancet. 2017;389(10065):211-224. https://doi.org/10.1016/S0140-6736(16)30951-5
3. Li Y, Tang XX. Abnormal airway mucus secretion induced by virus infection. Front Immunol. 2021;12:701443.
https://doi.org/10.3389/fimmu.2021.701443
4. Dezfouli SMM, Gharab SG, Hamidi R, Mahmoodi M, Nasirizade M, Ghafoury R, et al. Saline nebulizers in treatment of bronchiolitis. J Family Med Prim Care. 2024;13(11):4937-4942. https://doi.org/10.4103/jfmpc.jfmpc_244_24
5. Roe T, Talbot T, Terrington I, Johal J, Kemp I, Saeed K, et al. Physiology and pathophysiology of mucus and mucolytic use in critically ill patients. Crit Care. 2025;29(1):68.
https://doi.org/10.1186/s13054-025-05286-x
6. Zhang L, Mendoza-Sassi RA, Wainwright CE, Aregbesola A, Klassen TP. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev. 2023;4(4):CD006458. https://doi.org/10.1002/14651858.CD006458.pub5
7. Sakulchit T, Goldman RD. Nebulized epinephrine for young children with bronchiolitis. Can Fam Physician. 2016;62(12):991-993.
8. Deeney BT, Cao G, Orfanos S, Lee J, Kan M, Himes BE, et al. Epinephrine evokes shortening of human airway smooth muscle cells following β2 adrenergic receptor desensitization. Am J Physiol Lung Cell Mol Physiol. 2022;323(2):L142-L151.
https://doi.org/10.1152/ajplung.00444.2021
9. Alharbi AS, Yousef AA, Alharbi SA, Al-Shamrani A, Alqwaiee MM, Almeziny M, et al. Application of aerosol therapy in respiratory diseases in children: a Saudi expert consensus. Ann Thorac Med. 2021;16(2):188-218.
https://doi.org/10.4103/atm.atm_74_21
10. Hou YT, Shi Q, Zhang L, Cheng Q. Clinical advances in racemic epinephrine for pediatric croup: a mini-review of evidence and practice. Front Pediatr. 2025;13:1616521.
https://doi.org/10.3389/fped.2025.1616521
11. Hasan N, Ahmed F, Sultana AT, Ratan MNH, Islam MS, Halder K, et al. A comparative study of nebulized 3% hypertonic saline versus nebulized adrenaline in the treatment of acute bronchiolitis. Ann Int Med Dent Res. 2022;8(4):131-143.
https://doi.org/10.53339/aimdr.2022.8.4.16
12. Singh S, Kahlon PS, Neki NS. Comparative study to assess the efficacy of nebulised 3% hypertonic saline and nebulised L-adrenaline in treatment of acute bronchiolitis. Int J Curr Res Med Sci. 2017;3(5):77-83.
https://doi.org/10.22192/ijcrms.2017.03.05.012
13. Islam KT, Mollah AH, Matin A, Begum M. Comparative efficacy of nebulized 3% hypertonic saline versus 0.9% normal saline in children with acute bronchiolitis. Bangladesh J Child Health. 2018;42(2):130-137.
https://doi.org/10.3329/bjch.v42i3.39264
14. Salman MK, Ashraf MS, Ahmad E. Comparison of 3.0% hypertonic saline versus 0.9% normal saline nebulization for acute bronchiolitis in children. J Postgrad Med Inst. 2018;32(2):128-131.
15. Hossain RM, Shams S, Kader MA, Pervez M, Bhuiyan MFH, Hasan MM, et al. Efficacy of nebulized hypertonic saline versus normal saline and salbutamol in treating acute bronchiolitis. Int J Contemp Pediatr. 2022;9(6):523-528.
https://doi.org/10.18203/2349-3291.ijcp20221331
16. Safdar S, Ashraf S, Safdar Sh, Zafar Y, Naseem A, Mehboob HA. Role of nebulized epinephrine versus nebulized hypertonic saline in moderate bronchiolitis. Indus J Biosci Res. 2025;3(2):647-648.
https://doi.org/10.70749/ijbr.v3i2.646
17. Pereira RA, de Almeida VO, Zambrano M, Zhang L, Amantéa SL. Effects of nebulized epinephrine in association with hypertonic saline for infants with acute bronchiolitis: a systematic review and meta-analysis. Federal Univ Health Sci Porto Alegre. 2021.
https://doi.org/10.22541/au.162113107.72098189/v1
18. Sharmin S, Helaly L, Sarket ZH, Amin R, Ahmed S, Alam ST. Efficacy of nebulised L-adrenaline with 3% hypertonic saline versus normal saline in bronchiolitis. BSMMU J. 2014;7(1):15-19.
https://doi.org/10.3329/bsmmuj.v7i1.29141
19. Suleman M, Sadiq F, Khan MQ, Jabar A, Khan A, Musa N. Comparison of 3% normal saline nebulization versus steroid nebulization in the treatment of bronchiolitis. J Health Res Rev. 2023;3(2):472-473.
https://doi.org/10.61919/jhrr.v3i2.181
20. Saleem M, Saleem M, Khurshid A. Hypertonic saline versus normal saline nebulization in hospitalized children with acute bronchiolitis. Prof Med J. 2020;27(12):2734-2738.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
