Comparison of Efficacy of Nebulized Ventolin, Pulmicort and Normal Saline in Treatment of Children Under 2 Years Old with Bronchiolitis Admitted in Ahvaz Abuzar Hospital

Document Type : Original Research

Authors
M. Abdollah Zadeh 1
F. Abolnejadian 2
M. Alisamir 3
M. Reza Mirkarimi 4
M. Torabizadeh 5
1 Department of Pediatrics Pulmonology, Abuzar Children's Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
2 Department of Pediatrics Pulmonology, Abuzar Children's Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
3 Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
4 Department of Pediatric Pulmonology, Abuzar Children’s Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
5 Golestan Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Abstract
Background: Bronchiolitis is a common lower respiratory tract infection in infants. Apart from supportive care, no effective treatment for this disease has been identified so far. Accordingly, a double-blind randomized controlled trial was conducted on infants with a diagnosis of mild to moderate bronchiolitis. Material and Methods: Three clinical trial groups were designed, including Ventolin 0.15 mg/kg, Palmicort 125 mg twice a day, and normal saline nebulization every 4 hours. Clinical symptoms were monitored by asthma and allergy specialist daily, and the need for supplemental oxygen, recovery time from symptoms, and hospital days were recorded and compared between the three groups. Results: The results demonstrated that the frequency of oxygen requirement in both palmicort and normal saline groups was lower in compare to the ventolin group. But there was no significant difference between the three groups (P=0.765 and P=0.907, respectively). The duration of symptom improvement in the normal saline and palmicort group was significantly shorter than the Ventolin group (P=0.017). No significant difference was observed between the three groups of Ventolin, Pulmicort and normal saline during the treatment in terms of clinical score (P≥0.05). Conclusion: The obtained results showed that Ventolin or Palmicort nebulizer is not statistically better than normal saline for the treatment of children with bronchiolitis. Therefore, our results do not support the routine use of bronchodilators in the clinical setting for the management of mild to moderate forms of bronchiolitis in infants.

Keywords

Subjects

1. Alharbi AS, Alqwaiee M, Al-Hindi MY, Mosalli R, Al-Shamrani A, Alharbi S, et al. bronchiolitis in children: The Saudi initiative of bronchiolitis diagnosis, management, and prevention (SIBRO). Annals of thoracic medicine. 2018;13(3):127.
2. Zorc JJ, Hall CB. Bronchiolitis: recent evidence on diagnosis and management. Pediatrics. 2010;125(2):342-9.
3. Soleimani G, Shahri ES, Rashidi S, Salari Z, Moghadam AA. Epidemiology, Clinical, and Laboratory Characteristics of Bronchiolitis in Hospitalized Children. Journal of Comprehensive Pediatrics. 2014;5(3).
4. Bawazeer M, Aljeraisy M, Albanyan E, Abdullah A, Al Thaqafi W, Alenazi J. Effect of combined dexamethasone therapy with nebulized r-epinephrine or salbutamol in infants with bronchiolitis: a randomized, double-blind, controlled trial. Avicenna Journal of Medicine. 2014;4(3):58.
5. Hartling L, Fernandes RM, Bialy L, Milne A, Johnson D, Plint A, et al. Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis. Bmj. 2011;342:d1714.
6. Fernandes RM, Wingert A, Vandermeer B, Featherstone R, Ali S, Plint AC, et al. Safety of corticosteroids in young children with acute respiratory conditions: a systematic review and meta-analysis. BMJ open. 2019;9(8):e028511.
7. King VJ, Viswanathan M, Bordley WC, Jackman AM, Sutton SF, Lohr KN, et al. Pharmacologic treatment of bronchiolitis in infants and children: a systematic review. Archives of pediatrics & adolescent medicine. 2004;158(2):127-37.
8. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane database of systematic reviews. 2014(6).
9. Simsek-Kiper PÖ, Kiper N, Hasçelik G, Dolgun A, Yalcin E, Dogru-Ersöz D, et al. Emergency room management of acute bronchiolitis: a randomized trial of nebulized epinephrine. The Turkish Journal of Pediatrics. 2011;53(6):651.
10. Mojtaba KA, Fardin A, Naghi KSA, Koorosh K, Elham E. The priority of using hypertonic saline over ventolin in the treatment of bronchiolitis. Journal of Health Research and Reviews. 2016;3(3):98.
11. Zamani M-A, Movahhedi M, Nourbakhsh SM-K, Ganji F, Rafieian-Kopaei M, Mobasheri M, et al. Therapeutic effects of Ventolin versus hypertonic saline 3% for acute bronchiolitis in children. Medical journal of the Islamic Republic of Iran. 2015;29:212.
12. Johnson JE, Gonzales RA, Olson SJ, Wright PF, Graham BS. The histopathology of fatal untreated human respiratory syncytial virus infection. Modern Pathology. 2007;20(1):108-19.
13. Ipek IO, Yalcin EU, Sezer RG, Bozaykut A. The efficacy of nebulized salbutamol, hypertonic saline and salbutamol/hypertonic saline combination in moderate bronchiolitis. Pulmonary pharmacology & therapeutics. 2011;24(6):633-7.
14. Luo Z, Fu Z, Liu E, Xu X, Fu X, Peng D, et al. Nebulized hypertonic saline treatment in hospitalized children with moderate to severe viral bronchiolitis. Clinical microbiology and infection. 2011;17(12):1829-33.
15. Mandelberg A, Amirav I. Hypertonic saline or high volume normal saline for viral bronchiolitis: mechanisms and rationale. Pediatric pulmonology. 2010;45(1):36-40.
16. Köse S, Şehriyaroğlu A, Esen F, Özdemir A, Kardaş Z, Altuğ U, et al. Comparing the efficacy of 7%, 3% and 0.9% saline in moderate to severe bronchiolitis in infants. Balkan Medical Journal. 2016;33(2):193.
17. Kuzik BA, Al Qadhi SA, Kent S, Flavin MP, Hopman W, Hotte S, et al. Nebulized hypertonic saline in the treatment of viral bronchiolitis in infants. The Journal of pediatrics. 2007;151(3):266-70. e1.
18. Ralston S, Hill V, Martinez M. Nebulized hypertonic saline without adjunctive bronchodilators for children with bronchiolitis. Pediatrics. 2010;126(3):e520-e5.
19. Hatami G, Motamed N, Ilkhani Pak H. Effect of nebulized 3% hypertonic saline in the treatment of acute viral bronchiolitis in children. ISMJ. 2015;18(2):334-43.
20. Flores P, Mendes AL, Neto AS. A randomized trial of nebulized 3% hypertonic saline with salbutamol in the treatment of acute bronchiolitis in hospitalized infants. Pediatric pulmonology. 2016;51(4):418-25.
21. Ojha A, Mathema S, Sah S, Aryal U. A comparative study on use of 3% saline versus 0.9% saline nebulization in children with bronchiolitis. Journal of Nepal Health Research Council. 2014.
22. Silver AH, Esteban-Cruciani N, Azzarone G, Douglas LC, Lee DS, Liewehr S, et al. 3% hypertonic saline versus normal saline in inpatient bronchiolitis: a randomized controlled trial. Pediatrics. 2015;136(6):1036-43.
23. Smith DK, Seales SM, Budzik C. Respiratory syncytial virus bronchiolitis in children. American Family Physician. 2017;95(2):94-9.
24. Hassan S, Gonzalez A, Demissie S, Morawakkoralage K, James P. Nebulized normal saline solution for treatment of bronchial asthma exacerbations and bronchiolitis: not standard of care. Clinical Pediatrics. 2018 Nov;57(13):1582-7.
25. Anil AB, Anil M, Saglam AB, Cetin N, Bal A, Aksu N. High volume normal saline alone is as effective as nebulized salbutamol‐normal saline, epinephrine‐normal saline, and 3% saline in mild bronchiolitis. Pediatric pulmonology. 2010 Jan;45(1):41-7.
26. Mohammadzadeh I, Mohammadi M, Khodabakhsh E. The effect of nebulised salbutamol plus magnesium sulfate in comparison with nebulised salbutamol plus normal saline in acute asthmatic attack in children. Journal of Babol University of Medical Sciences. 2014 Mar 10;16(3):7-12.
27. Khashabi J, Salarilak S, Karamiyar M, Mussavi H. Comparison of the efficacy of nebulized L-epinephrine, salbutamol and normal saline in acute bronchiolitis: a randomized clinical trial. Medical Journal of the Islamic Republic of Iran. 2005;19(2):119-25.
28. Khashabi J, Salarilak S, Karamiyar M, Mussavi H. Comparison of the efficacy of nebulized L-epinephrine, salbutamol and normal saline in acute bronchiolitis: a randomized clinical trial. Medical Journal of the Islamic Republic of Iran. 2005;19(2):119-25.
29. Marques L, Vale N. Salbutamol in the management of asthma: A review. International Journal of Molecular Sciences. 2022 Nov 17;23(22):14207.
30. KIPS JC, O'CONNOR BJ, INMAN MD, SVENSSON K, PAUWELS RA, O'BYRNE PM. A long-term study of the antiinflammatory effect of low-dose budesonide plus formoterol versus high-dose budesonide in asthma. American journal of respiratory and critical care medicine. 2000 Mar 1;161(3):996-1001.
31. Anil AB, Anil M, Saglam AB, Cetin N, Bal A, Aksu N. High volume normal saline alone is as effective as nebulized salbutamol‐normal saline, epinephrine‐normal saline, and 3% saline in mild bronchiolitis. Pediatric pulmonology. 2010 Jan;45(1):41-7.
32. Kua KP, Lee SW. Systematic review and meta-analysis of the efficacy and safety of combined epinephrine and corticosteroid therapy for acute bronchiolitis in infants. Frontiers in pharmacology. 2017;8:396.
33. Mittal V, Darnell C, Walsh B, Mehta A, Badawy M, Morse R, et al. Inpatient bronchiolitis guideline implementation and resource utilization. Pediatrics. 2014;133(3):e730-e7.
34. Meissner HC. Viral bronchiolitis in children. New England Journal of Medicine. 2016;374(1):62-72.
35. Wang ZY, Li XD, Sun AL, Fu XQ. Efficacy of 3% hypertonic saline in bronchiolitis: A meta‑analysis. Experimental and Therapeutic Medicine. 2019;18(2):1338-44.
36. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. The Cochrane database of systematic reviews. 2014;2014(6):CD001266-CD. doi:10.1002/14651858.CD001266.pub4. [PubMed:24937099].
37. Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. The Cochrane database of systematic reviews. 2013;2013(6):CD004878-CD. doi:10.1002/14651858.CD004878.pub4. [PubMed:23733383].
38. Simşek-Kiper PO, Kiper N, Hasçelik G, Dolgun A, Yalçin E, Doğru-Ersöz D, et al. Emergency room management of acute bronchiolitis: a randomized trial of nebulized epinephrine. Turk J Pediatr. 2011;53(6):651-60. [PubMed:22389988].
39. Anil AB, Anil M, Saglam AB, Cetin N, Bal A, Aksu N. High volume normal saline alone is as effective as nebulized salbutamol-normal saline, epinephrine-normal saline, and 3% saline in mild bronchiolitis. Pediatr Pulmonol. 2010;45(1):41-7. doi:10.1002/ppul.21108. [PubMed:19953579].
40. Hatami G, Motamed N, Ilkhani Pak H. Effect of nebulized 3% hypertonic saline in the treatment of acute viral bronchiolitis in children. Iranian South Medical Journal. 2015;18(2):334-43.
41. Köse S, Şehriyaroğlu A, Esen F, Özdemir A, Kardaş Z, Altuğ U, et al. Comparing the Efficacy of 7%, 3% and 0.9% Saline in Moderate to Severe Bronchiolitis in Infants. Balkan medical journal. 2016;33(2):193-7. doi:10.5152/balkanmedj.2016.16840. [PubMed:27403389].
42. Flores P, Mendes AL, Neto AS. A randomized trial of nebulized 3% hypertonic saline with salbutamol in the treatment of acute bronchiolitis in hospitalized infants. Pediatr Pulmonol. 2016;51(4):418-25. doi:10.1002/ppul.23306. [PubMed:26334188].
43. Ojha AR, Mathema S, Sah S, Aryal UR. A comparative study on use of 3% saline versus 0.9% saline nebulization in children with bronchiolitis. J Nepal Health Res Counc. 2014;12(26):39-43. [PubMed:25574983].
44. Silver AH, Esteban-Cruciani N, Azzarone G, Douglas LC, Lee DS, Liewehr S, et al. 3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial. Pediatrics. 2015;136(6):1036-43. doi:10.1542/peds.2015-1037. [PubMed:26553190].
45. De Brasi D, Pannuti F, Antonelli F, de Seta F, Siani P, de Seta L. Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs? Italian journal of pediatrics. 2010;36:67-. doi:10.1186/1824-7288-36-67. [PubMed:20920314].
46. Hervás D, Reina J, Yañez A, del Valle JM, Figuerola J, Hervás JA. Epidemiology of hospitalization for acute bronchiolitis in children: differences between RSV and non-RSV bronchiolitis. Eur J Clin Microbiol Infect Dis. 2012;31(8):1975-81. doi:10.1007/s10096-011-1529-y. [PubMed:22240853].
47. Cunningham S, Rodriguez A, Adams T, Boyd KA, Butcher I, Enderby B, et al. Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet (London, England). 2015;386(9998):1041-8. doi:10.1016/s0140-6736(15)00163-4. [PubMed:26382998].
48. Green P, Aronoff SC, DelVecchio M. The Effects of Inhaled Steroids on Recurrent Wheeze After Acute Bronchiolitis: A Systematic Review and Meta-Analysis of 748 Patients. Glob Pediatr Health. 2015;2:2333794x15595964. doi:10.1177/2333794x15595964. [PubMed:27335972].
49. Cade A, Brownlee KG, Conway SP, Haigh D, Short A, Brown J, et al. Randomised placebo controlled trial of nebulised corticosteroids in acute respiratory syncytial viral bronchiolitis. Archives of disease in childhood. 2000;82(2):126-30. doi:10.1136/adc.82.2.126. [PubMed:10648365].
50. Lan WP, Wang J, Dai CL, Pan JH. [Efficacy of fluticasone propionate aerosol versus budesonide suspension in treatment of recurrent wheezing caused by bronchiolitis]. Zhongguo Dang Dai Er Ke Za Zhi. 2016;18(4):316-9. [PubMed:27097575].
51. Ipek IO, Yalcin EU, Sezer RG, Bozaykut A. The efficacy of nebulized salbutamol, hypertonic saline and salbutamol/hypertonic saline combination in moderate bronchiolitis. Pulm Pharmacol Ther. 2011;24(6):633-7. doi:10.1016/j.pupt.2011.09.004. [PubMed:21978929].
52. Mojtaba K, Fardin A, Ali Naghi K, Koorosh K, Elham E. The priority of using hypertonic saline over ventolin in the treatment of bronchiolitis. Journal of Health Research and Reviews. 2016;3(3):98-101. doi:10.4103/2394-2010.193180.
53. Zamani MA, Movahhedi M, Nourbakhsh SM, Ganji F, Rafieian-Kopaei M, Mobasheri M, et al. Therapeutic effects of Ventolin versus hypertonic saline 3% for acute bronchiolitis in children. Med J Islam Repub Iran. 2015;29:212. [PubMed:26478870].
54. Ipek IO, Yalcin EU, Sezer RG, Bozaykut A. The efficacy of nebulized salbutamol, hypertonic saline and salbutamol/hypertonic saline combination in moderate bronchiolitis. Pulmonary pharmacology & therapeutics. 2011;24(6):633-7.
Pathobiology Reserach
Volume 27, Issue 3
November 2024
Pages 19-29