Objective: To determine the utility of inhaled hypertonic saline solution to treat ambulatory infants with viral bronchiolitis.

Design: Randomized, double-blind, controll trial. Sixty-five ambulatory infants (mean [+ or -] SD age, 125 [+ or -] 6 months) with viral bronchiolitis received either of the following: inhalation of 05 mL (5 mg) terbutaline added to 2 mL of 09% saline solution as a wet nebulized aerosol (control; collection 1; n = 32) or 05 mL (5 mg) terbutaline added to 2 mL of 3% saline solution administered in the same manner as above (treatment; arrange 2; n = 33). This therapy was repeated three times each day for 5 days.

Results: The clinical severity (CS) scores at baseline forward the first day of treatment were 64 [+ or -] 18 in collection 1 and 6.6 [+ or -] 15 in collection 2 (not significant). After the first day, the C score was significantly lower (better) in arrange 2 as compared to form into groups 1 on each of the treatment days (p < 0005; Fig 1) onward the first day, the percentage decrease in the C score after inhalation therapy was significantly better for clump 2 (33%) than for assemblage 1 (13%) [p < 0005; Fig 1] forward the second day, the percentage improvement was better in the hypertonic saline solution-treated patients (group 2) as compared to the 09% saline solution-treated patients (group 1) [p = 001; Fig 1]

[FIGURE 1 OMITTED]

Conclusions: We judge that in nonasthmatic, nonseverely ill ambulatory infants with viral bronchiolitis, aerosolized 3% saline solution plus 5 mg terbutaline is effective in decreasing symptoms as compared to 09% saline solution plus 5 mg terbutaline.

key-note words: ambulatory; [[beta].sub.2]-agonist; hypertonic saline solution; respiratory syncytial virus; terbutaline; viral bronchiolitis

Abbreviations. CF = cystic fibrosis; C = clinical severity; N = not significant; RA = radiograph assessment; RSV = respiratory syncytial virus

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Virtually all children acquire respiratory syncytial virus (RSV) infection within 2 years after birth (1-3); simply 1% require hospitalization. (1,4) Therefore, therapies that decrease symptoms and morbidity in ambulatory children with RSV bronchiolitis are of benefit and could potentially cut down health-care expenditures. Despite 4 decades of efforts, there are no effective means to have charge of RSV. (1) Currently, controversies exist from one side of to the other the available treatments for acute bronchiolitis. (15) Antiviral agents so as ribavirin are available, yet their use in most patients is controversial and therefore not indicated, especially in ambulatory patients. (5-10) principally of the studies using glucocorticoids in the treatment of bronchiolitis denied a positive therapeutic meaning in previously normal children with bronchiolitis. (51112) The use of adrenergic agonists occasionally issueed in a short-term improvement in patients with bronchiolitis, (13-16) while others failed to present to view a significant effect. (5,17)

Pathophysiologically, bronchiolitis is an infection of the bronchiolar epithelium, with following profound submucosal and adventitial edema, increased secretion of mucus, peribronchiolar mononuclear infiltration, and epithelial lonely dwelling necrosis. These changes obstruct spring in the small airways, leading to hyperinflation, atelectasis, and wheezing. (1518) A single inhalation of recombinant human deoxyribonuclease has been lately used as a mucolytic agent in RSV bronchiolitis with near success. (19) However, this expensive unsalable article was administered only once to each baby criterioned and had no effect upon the length of hospital stay, nor did it improve post-inhalation therapy clinical severity (CS) scores significantly. (19) A more cost-effective put drugs into is urgently needed for this purpose

Hypertonic saline solution, from absorbing water from the submucosa, can theoretically overturn some of the submucosal and adventitial edema and improve the clearance of the thick mucus plaques inside the bronchiolar lumen It has been shown to increase mucociliary transit time in various situations: in vitro, in normal controls in patients, with cystic fibrosis, and in patients with sinonasal diseases. (20-28)

In our region, the now passing standard inhalation therapy of ambulatory babies with acute bronchiolitis consists of [[beta].sub.2]-agonists--terbutaline or albuterol--diluted in normal saline solution. We hypothesized that simply substituting normal saline solution for hypertonic saline solution in the inhalation mixture for delivering terbutaline to these babies may improve C scores after inhalations and decrease hospitalization rates.

MATERIALS AND METHODS

This was a randomized, double-blinded, controll trial. Signed informed compliance was obtained from the parents of each child, and the human ethics committee of our hospital approved the research according to the principles of the Declaration of Helsinki. Seventy infants who existinged to the Pediatrics and Adolescent Ambulatory Community Clinic of General Health Services of Petach-Tikva for acute viral bronchiolitis during the winter of 2000-2001 were recruited. The inclusion criterion was clinical presentation of mild-to-moderate viral bronchiolitis. Exclusion criteria were as follows: cardiac illness, chronic respiratory disease, previous wheezing episode, age [greater than or equal to] 24 month oxygen saturation < 96% forward room air, and need for hospitalization.

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