Farmacoriflessioni
Soluzioni ipertoniche in aerosol? Anche no, grazie
Nebulised hypertonic saline? Maybe not, thanks
Luciano Anfossi1, Roberta Calzedda2
1Dipartimento di Pediatria, Ospedale Infantile “Regina Margherita”, Città della Salute e della Scienza di Torino
2Scuola di Specializzazione in Pediatria, Università di Torino
Dicembre 2019 - pagg. 634 -638
Abstract
Nebulised hypertonic saline (HS) - usually 3% - has become part of paediatric practice for
the management of respiratory diseases such as bronchiolitis and preschool wheezing.
Acute bronchiolitis is a common disorder in infancy and often results in hospitalisation.
No therapy has been shown to influence the course of the disease, other than supportive
care. The quality of evidence of studies on positive effects of 3% nebulised saline is low to
moderate and new analyses show no benefit. Prospective blinded studies concerning HS
use in preschool children with acute viral wheezing are limited. Moreover, HS can induce
bronchonconstriction and worsening of cough and should be used with caution especially
in patients with bronchial hyperresponsiveness. Other drugs too are used for nebulisation
(i.e. mucolytics) despite their unknown physical properties. The hypertonicity-induced bronchospasm
can be prevented with the concurrent use of salbutamol.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Contenuto riservato
Per leggere l'articolo completo è necessario effettuare il login.
Non sei ancora registrato? Registrati
Bibliografia
1. Meissner HC. Viral Bronchiolitis in Children.
N Engl J Med 2016;5;374(18):1793-4.
2. Ralston SL, Lieberthal AS, Meissner HC,
et al. Clinical practice guideline: the diagnosis,
management, and prevention of bronchiolitis.
Pediatrics 2014;134:e1474.
3. Caffrey Osvald E, Clarke JR. Bronchiolitis
in children: diagnosis and management. Arch
Dis Child Educ Pract Ed 2016;101(1):46-8.
4. Baraldi E, Lanari M, Manzoni P, et al. Inter-
society consensus document on treatment
and prevention of bronchiolitis in newborns
and infants. Ital J Pediatr 2014;40:65.
5. Mandelberg A, Amirav I. Hypertonic saline
or high volume normal saline for viral bronchiolitis:
mechanisms and rationale. Pediatr
Pulmonol 2010;45(1):36-40.
6. Cozzi G, Pusceddu S, Mambelli L, Barbi E,
Marchetti F. Le nuove linee guida sulla bronchiolite.
Medico e Bambino 2015;34:369-75.
7. Sarrell EM, Tal G, Witzling M, et al. Nebulized
3% hypertonic saline solution treatment
in ambulatory children with viral bronchiolitis
decreases symptoms. Chest 2002;122(6):
2015-20.
8. Zhang L, Mendoza-Sassi RA, Wainwright C,
Klassen TP. Nebulised hypertonic saline solution
for acute bronchiolitis in infants. Cochrane
Database Syst Rev 2017;12:CD006458.
9. Flores P. 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.
10. Angoulvant F, Bellêttre X, Milcent K, et
al. Efficacy of 3% Hypertonic Saline in Acute
Viral Bronchiolitis (GUERANDE) Study
Group. Effect of nebulized hypertonic saline
treatment in Emergency Departments on the
hospitalization rate for acute bronchiolitis: a
randomized clinical trial. JAMA Pediatr 2017;
171(8):e171333.
11. Silver AH, Esteban-Cruciani N, Azzarone
G et al. 3% Hypertonic saline versus normal
saline in inpatient bronchiolitis: a randomized
controlled trial. Pediatrics 2015;136(6):
1036-43.
12. Florin TA, Shaw KN, Kittick M, Yakscoe
S, Zorc JJ. Nebulized hypertonic saline for
bronchiolitis in the emergency department: a
randomized clinical trial. JAMA Pediatr 2014;
168(7):664-70.
13. Morikawa Y, Miura M, Furuhata MY, et
al. Nebulized hypertonic saline in infants hospitalized
with moderately severe bronchiolitis
due to RSV infection: a multicenter randomized
controlled trial. Pediatr Pulmonol
2018;53(3):358-65.
14. Everard ML, Hind D, Ugonna K, et al. SABRE:
a multicentre randomised control trial
of nebulised hypertonic saline in infants hospitalised
with acute bronchiolitis. Thorax
2014;69:1105-12.
15. Brooks CG, Harrison WN, Ralston SL.
Association between hypertonic saline and
hospital length of stay in acute viral bronchiolitis:
a reanalysis of 2 meta-analyses.
JAMA Pediatr 2016;170(6):577-84.
16. Everard M, Maguire C, Cantrill H, Hind
D. Late-breaking abstract: hypertonic saline
(HS) for acute bronchiolitis: systematic review
and meta-analysis. ERJ 2014;44:(Suppl
58):P1226.
17. Grewal S, Klassen TP. The tale of 2 trials:
disentangling contradictory evidence on hypertonic
saline for acute bronchiolitis. JAMA
Pediatr 2014;168:607-9.
18. When two trials conflict: bronchiolitis and
hypertonic saline. Arch Dis Child 2014;99:
1054.
19. Harrison W, Angoulvant F, House S et al.
Hypertonic saline in bronchiolitis and type I
error: a trial sequential analysis. Pediatrics
2018;142(3).
20. Pusceddu S, Cozzi G. Soluzione salina
ipertonica in caso di bronchiolite acuta: fare
meno è fare mdi più? Medico e Bambino
2015;34:581-584.
21. Marchetti F, Barbi E. Medicina basata
sulle evidenze o evidenze basate sulla medicina?
Medico e Bambino 2015;34(9):551-2.
22. Legg JP, Cunningham S. Hypertonic saline
for bronchiolitis: a case of less is more.
Arch Dis Child 2015;100(12):1104-5.
23. Martinez FD. Development of wheezing
disorders and asthma in preschool children.
Pediatrics 2002;109(2 Suppl):362-7.
24. Brand PL, Baraldi E, Bisgaard H, et al.
Definition, assessment and treatment of
wheezing disorders in preschool children: an
evidence-based approach. Eur Respir J 2008;
32(4):1096-110.
25. Ater D, Shai H, Bar BE, et al. Hypertonic
saline and acute wheezing in preschool children.
Pediatrics 2012;129(6):e1397-403.
26. Kanjanapradap T, Deerojanawong J, Sritippayawan
S, Prapphal N. Does nebulized
hypertonic saline shorten hospitalization in
young children with acute viral wheezing?
Pediatr Pulmonol 2018;53(2):138-44.
27. Korppi M. Hypertonic saline in viral wheezing.
Pediatr Pulmonol 2018;53(5):533-4.
28. Ortiz-Alvarez O. Acute management of
croup in the emergency department. Paediatr
Child Health 2017;22(3):166-73.
29. AIR, SIMRI, SIAIP. Position paper. Aerosol
terapia in età pediatrica. 2019.
30. Wark P, McDonald VM. Nebulised hypertonic
saline for cystic fibrosis. Cochrane
Database Syst Rev 2018;9:CD001506.
31. Tarrant BJ, Le Maitre C, Romero L, et al.
Mucoactive agents for chronic, non-cystic fibrosis
lung disease: a systematic review and
meta-analysis. Respirology 2017;22(6):1084-92.
32. Balsamo R, Lanata L, Egan CG. Mucoactive
drugs. Eur Respir Rev 2010;19:127-33.
33. Portel L, Tunon de Lara JM, Vernejoux
JM, Weiss I, Taytard A. [Osmolarity of solutions
used in nebulization]. Rev Mal Respir
1998;15(2):191-5.
34. Rubin BK. Aerosol medications for treatment
of mucus clearance disorders. Respir
Care 2015;60(6):825-9; discussion 830-32.
35. Marchetti F. La prescrizione dei mucolitici:
tra provvedimenti restrittivi e ricerca delle
evidenze. Medico e Bambino 2011;30(1):7-32.
Corrispondenza: roberta.calzedda@gmail.com