Hypertonic saline nebulization for bronchiolitis.

Bronchiolitis is regarded as the most common lower respiratory tract infection among infants in developed countries(1). In our country too, it is a significant problem judging by the frequency of wheezing episodes among young infants, though it is difficult to routinely identify the causative virus(es). Management of bronchiolitis is often frustrating for physicians and care-givers because ‘nothing seems to work’ in most cases. There is lack of robust evidence for almost all the interventions that are usually tried, including inhaled epinephrine(2), bronchodilators(3), steroids(4), anticholinergics(5), antibiotics(6), surfactant(7) and chest physiotherapy(8). Some experts have questioned whether bronchiolitis can be treated at all(9), and current research data is far from adequate to draw definite conclusions. It has been suggested that hypertonic saline nebulization may be useful in making secretions less viscous and promoting their excretion, thereby resulting in clinical improvement. Despite the lack of sufficient data, many physicians use this, though sometimes more for psychological than clinical benefit. Against such a background, it is relevant to ask the clinical question, “In infants with bronchiolitis (population), does hypertonic saline nebulization (intervention) result in better clinical response (outcome) compared to no intervention or nebulization with normal saline (comparison)”.