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Bronchiolitis is common in children below 2 years of age and is a leading cause of infant hospitalisation, accounting for $1.73 billion in hospital charges in the USA annually.1 The putative effect of hypertonic saline (HTS) in bronchiolitis is to absorb mucosal water, hydrate the airway–surface liquid in the bronchioles and enhance mucociliary clearance.2 However, the therapeutic value of HTS in acute bronchiolitis remains unclear.
Both randomised controlled trials (RCTs) were conducted in urban, tertiary level, paediatric emergency departments (ED) in the USA. They excluded children with significant comorbidity, and compared the effect of nebulised 3% HTS with normal saline (NS) controls. Both studies used albuterol, given either just prior to or within 90 min of HTS.
Florin and colleagues enrolled 31 patients in each group, concluding that improvement in Respiratory Assessment Change Score (RACS; primary outcome) 1 h after intervention was less …