Brief introduction
This paper provides a brief but comprehensive proposal for research into the use of nebulized hypertonic saline as alternative management of bronchiolitis in children. The proposed research method will be a qualitative review of current and recent literature, which has identified gaps in the existing knowledge. Currently, a number of studies have shown that nebulized hypertonic saline has yielded positive results in the management of bronchiolitis. Several years ago, the use of hypertonic saline in treating adjunct therapy in individuals with bronchiolitis was found to be effective in India (Sarrell et al. 2012). Since then, there have been a number of studies to advance this knowledge. Nevertheless, despite several studies showing positive results, few studies have attempted to develop a review, analysis and compilation of the information from the empirical studies. Thus, this study will attempt to review the existing literature and compile the information therein in order to determine whether hypertonic saline is an alternative treatment for child bronchiolitis.
Brief Review of Literature
Indian pediatrics were among the first individuals to show that hypertonic saline can act as an adjunct therapy in managing infant bronchiolitis. They concluded robust evidence to include hypertonic saline in practice was greatly lacking. Nevertheless, Cochrane systematic review suggested that some evidence of the positive effect of hypertonic saline was available. This review, which was published almost at the same time as the report from the Indian Pediatrics, indicated a significant reduction in clinical severity of the condition in individuals who had received hypertonic saline as an alternative treatment. Since then, a number of studies have attempted to investigate these hypotheses.
A study by Grewal et al. (2009) attempted to determine whether hypertonic saline in which epinephrine was added was more effective than nebulized saline with epinephrine in the management of bronchiolitis. Using a randomized clinical trial that was double-blinded, the researchers attempted to determine the impact of the method on infants less than one year. It was found that hypertonic saline and epinephrine did not show any evidence of better outcomes than normal saline and epinephrine (Anil et al. 2010). In fact, this study refuted some claims by previous studies that had shown that the reverse was true (Al-Ansari et al. 2010).
According to a study by Al-Ansari et al (2010), nebulized 5% hypertonic saline is safer than 3% and 0.9% saline in treating children with bronchiolitis. It was found that this saline could be generalized in managing the condition even in older children. A study by Luo et al. (2011) attempted to determine the efficacy and safety of the nebulized hypertonic saline that is used as an inhaler in infants diagnosed with moderate to several bronchiolitis. With a clinical trial focusing on 126 children, the researchers found that the frequently inhaled hypertonic saline was effective in relieving symptoms of bronchiolitis faster than the normal saline (Luo et al. 2010). In addition, it was shown that this form of saline shortened the length of stay for the children by a relatively large margin. According to Kuzik et al. (2007), nebulized 3% hypertonic saline is a safe method for treating bronchiolitis in children, especially infants hospitalized with viral bronchiolitis.
Additional studies have attempted to determine the effectiveness of combining hypertonic saline with epinephrine in managing the condition, especially in infants. For instance, a study by Tal et al. (2006) found that a combination of nebulized 3% saline combined with epinephrine shows significant effectiveness of improving clinical outcomes in children hospitalized with viral bronchiolitis. It was further found that salbutamol combined with nebulized hypertonic saline improves the clinical outcomes of infants, but the effectiveness was relatively similar to the outcomes gained when salbutamol is combined with normal saline (Ipek et al. 2011).
Hypertonic saline mixed with one or more drugs such as epinephrine or salbutamol has been found to be an effective, safe but relatively inexpensive means of treating the condition, especially in infants.
Lacunae in the existing literature
Despite the presence of a wide volume of literature about the effectiveness of hypertonic saline in managing bronchiolitis in young children, it is clear that a number of issues are missing out. They also attempted to show that hypertonic saline is effective once used together with other treatments such as in combination with salbutamol or epinephrine. However, few studies have attempted to show the effectiveness of nebulized hypertonic saline as an alternative treatment, especially when used alone. In addition, few studies that have attempted to examine this phenomenon have not published adequate information. Moreover, the information available has not been developed in a critical review and compilation, yet it is possible that some of these studies with nebulized hypertonic saline alone could hold the key to the success of managing infant bronchiolitis.
Brief discussion
Although the prevalence and morbidity of bronchiolitis are relatively high, the existing therapies are controversial while widely accepted therapeutic guidelines and supportive care are lacking. In children, plugging of the airway, excessive mucus, edema and sloughed epithelium are common symptoms (Zhang et al. 2008). These symptoms prove difficult to manage, especially in infants. Nebulized bronchodilators have been the most common intervention protocols widely in use. However, extensive evidence shows that the benefits associated with these methods are limited, short-term and have no impact on the inflammation problem that is common in bronchiolitis patients (Mandelberg et al. 2012).
Thus, nebulized hypertonic saline is one of the few intervention methods that have shown evidence of reducing inflammation as well as all the other symptoms of the condition. Various studies have shown that when used in combination with other methods such as drugs, nebulized hypertonic saline is effective and enhances the healing process. Thus, research is needed to compile these studies in order to develop effective and standard guidelines for using hypertonic saline as an alternative treatment in infants.
Expected results
It is expected that the majority of the research materials analyzed, especially those developed in the last five years, support the hypothesis that nebulized hypertonic saline is effective in treating the condition. It is expected that more than 90% of the past studies show that nebulized hypertonic saline, whether used in a combination with other methods or alone, increases the healing process, which means that it is an alternative treatment method (Elkins et al. 2006).
Summary of expected conclusions
Empirical studies with children aged less than one year show that bronchiolitis is easily managed with nebulized hypertonic saline. Saline not only reduces the symptoms but also interferes with inflammation of the epithelium, thus increasing the healing process. This means that saline is usable in both viral and non-viral bronchiolitis (Hom & Fernandes 2011).
References
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Anil, AB, Anil, M, Saglam, AB, Cetin, Bal, A, & Aksu, N 2010, ‘High volume normal saline alone is as effective as nebulized salbutamol‐normal saline, epinephrine‐normal saline, and 3% saline in mild bronchiolitis’, Pediatric Pulmonology, vol. 45, no. 1, pp. 41-47.
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