New Treatment for Preschoolers with Acute Wheezing

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Most acute wheezing episodes in preschool children lead to airway dehydration. Together with other factors, airway dehydration causes the body to have trouble clearing mucus. These children do not respond well to available treatments. A new study published in the journal Pediatrics evaluated the effect of administering inhaled hypertonic saline to wheezing preschool children, which promotes airway hydration and thus mucus clearance [1].

photo credit: MinivanNinja

Wheezing occurs when the small airways in the lungs become inflamed and constricted, resulting in difficulty exhaling and shortness of breath. While commonly associated with asthma, not all wheezing is asthma attack-related or confined to those with allergies, particularly in young children. Among preschoolers, the most common cause of wheezing is upper respiratory infection [2]. While adults generally respond well to bronchodilators (including so-called “rescue inhalers,” which contain the medication albuterol) for acute wheezing and steroids for long-term management, young children are less likely to gain relief from these measures [3].

The new study examined the effect of administering inhaled hypertonic saline — a saltwater solution with a higher concentration of salt than the normal body secretions — together with albuterol [1]. The authors compared the effectiveness of this treatment to a placebo consisting of inhaled albuterol together with normal saline (a saltwater solution with the same concentration of salt as found in body secretions).

While the study was small, involving only 41 children, the results were nevertheless quite interesting. Compared to those receiving normal saline and albuterol, the hypertonic saline group had a shorter hospital admission rate (62.2%, versus 92% in the normal saline group) and, if admitted, a shorter length of stay (2 days versus 3).

While this small pilot study was the first to examine the effect of hypertonic saline in wheezing preschoolers, the theory behind the experiment was sound. Hypertonic saline helps reduce the duration and severity of wheezing episodes because it draws water into the mucosal layer of the lungs, loosening secretions. Coughing then clears the secretions more easily, reducing the degree to which small airways are blocked. Furthermore, hypertonic saline draws water out of the lung tissues, reducing swelling and improving airflow. While more studies are needed before results can be considered conclusive, there appears to be no negative effects associated with administration of hypertonic saline, making it a low-risk and potentially high-benefit intervention.

References:

1. Ater et al. Hypertonic saline and acute wheezing in preschool children. Pediatrics. 2012 Jun;129(6):e1397-403. Epub 2012 May 21.
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2. Brand et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J. 2008 Oct;32(4):1096-110.
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3. Bush, A. Practice imperfect–treatment for wheezing in preschoolers. N Engl J Med. 2009 Jan 22;360(4):409-10.
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