Inhalation use of hypertonic 3% solution of sodium chloride in children in world practice

April 16, 2024
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According to the Global Burden of Disease Study, the use of antibiotics prevents mortality from lower respiratory tract infections in 30.2% of cases. However, when using them, the development of resistance is often observed, that’s why it is worth to pay attention to nebulizer therapy with anti-inflammatory agents, the appointment of which would reduce the severity of inflammation in the respiratory tract in the early stages of treatment and prevent the progression of respiratory diseases and prescribing antibiotics. 3% hypertonic solution of sodium chloride is one of the powerful anti-inflammatory and immunomodulatory agents. The guidelines of the American Academy of Pediatrics indicate that inhalation use of 3% saline is a safe and effective way to relieve the symptoms of mild to moderate bronchiolitis after 24 hours of use and to reduce the length of hospitalization when it is more, than 3 days. Hypertonic solution of sodium chloride is included in the list of mandatory prescriptions in the treatment of patients with cystic fibrosis. However, some researchers report that during long-term inhalations with a hypertonic saline, the development of such side effects as: intense cough, bronchospasm, shortness of breath, throat irritation, a feeling of tightness in the chest and a salty taste can be noted. In this aspect, the combination of 3% saline with hyaluronic acid is useful, which will reduce the severity of side effects that can be observed during monotherapy with hypertonic saline, improving mucus removal and increasing the effectiveness of treatment of respiratory diseases in children.

References

  • 1. GBD 2016 Lower Respiratory Infections Collaborators. (2018) Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect. Dis., 18(11): 1191–1210.
  • 4. Goossens H., Ferech M., Vander Stichele R. et al. (2005) Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet, 365: 579–587.
  • 6. Zaytoun T.M., Dahroug A.H., Abdella H.M. (2017) Role of Hypertonic Saline Nebulization Therapy in Patients with Early Acute Respiratory Distress Syndrome. Bio life, 5(1): 74–84.
  • 8. Reeves E.P., Williamson M., O’Neill S.J. et al. (2011) Nebulized hypertonic saline decreases IL-8 in sputum of patients with cystic fibrosis. Am. J. Respir. Critical Care Med., 183: 1517–1523.
  • 9. Angle N., Hoyt D.B., Coimbra R. et al. (1998) Hypertonic saline resuscitation diminishes lung injury by suppressing neutrophil activation after hemorrhagic shock. Shock, 9: 164–170.
  • 10. Mandelberg A., Amirav I. (2010) Hypertonic saline or high volume normal saline for viral bronchiolitis: mechanisms and rationale. Ped. Pulmonol., 45(1): 36–40.
  • 11. Zhang L., Mendoza-Sassi R.A., Wainwright C. et al. (2013) Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane database Syst. Rev., 7: CD006458.
  • 12. Ralston S.L., Lieberthal A.S., Meissner H.C. et al. (2014) Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics, 134(5): e1474–e1502.
  • 14. Piedimonte G., Perez M.K. (2014) Respiratory syncytial virus infection and bronchiolitis. Ped. Rev., 35(12): 519–530.
  • 15. Baron J., El-Chaar G. (2016) Hypertonic saline for the treatment of bronchiolitis in infants and young children: a critical review of the literature. J. Pediatric Pharmacol. Therapeut., 21(1): 7–26.
  • 16. Zhang L., Gunther C.B., Franco O.S. et al. (2018) Impact of hypertonic saline on hospitalization rate in infants with acute bronchiolitis: A meta-analysis. Pediatr.Pulmonol., 53(8): 1089–1095.
  • 17. Hsieh C.W., Chen C., Su H.C. et al. (2020) Exploring the efficacy of using hypertonic saline for nebulizing treatment in children with bronchiolitis: a meta-analysis of randomized controlled trials. BMC Pediatrics, 20: 434.
  • 20. Zhang L., Mendoza-Sassi R.A., Wainwright C.E. et al. (2023) Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database of Syst. Rev., 4: CD006458.
  • 21. Ministry of Нealth of Ukraine. Order on July 15, 2016 No 723. On Adoption and Implementation of Medical and Technological Documents on the Standardization of Medical Care for Cystic Fibrosis.
  • 22. Terlizzi V., Masi E., Francalanci M. et al. (2021) Hypertonic saline in people with cystic fibrosis: review of comparative studies and clinical practice. Ital. J. Pediatr., 47(1): 168.
  • 23. Reeves E.P., Molloy K., Pohl K., McElvaney N.G. (2012) Hypertonic saline in treatment of pulmonary disease in cystic fibrosis. Sci. World J., 2012: 465230. doi:10.1100/2012/465230.
  • 24. Ilchenko S., Fialkovska A., Cherhinets V., Skriabina K. (2021) Comparison of the efficacy and tolerability of inhaled hypertonic salines of sodium chloride in pediatric practice. Med. perspekt., 26(1): 136–142. doi:10.26641/2307-0404.2021.1.227953.
  • 25. Subbarao P., Stanojevic S., Brown M. et al. (2013) Lung clearance index as an outcome measure for clinical trials in young children with cystic fibrosis. A pilot study using inhaled hypertonic saline. Am. J. Respir. Crit. Care Med., 188(4): 456–460.
  • 26. Southern K.W. (2019) Sinha IP Inhaled hypertonic saline for 3–6-year-olds with cystic fibrosis. Lancet Respir. Med., 7: 730–732.
  • 27. Buonpensiero P., De Gregorio F., Sepe A. et al. (2010) Hyaluronic acid improves «pleasantness» and tolerability of nebulized hypertonic saline in a cohort of patients with cystic fibrosis. Adv. Ther., 27: 870–878.
  • 28. Maiz Carro L., Martínez-García M.A. (2020) Use of hyaluronic acid (HA) in chronic airway diseases. Cells, 9(10): 2210.
  • 29. Chistyakov D.V., Astakhova A.A., Azbukina N.V. et al. (2019) High and low molecular weight hyaluronic acid differentially influences oxylipins synthesis in course of neuroinflammation. Int. J. Mol. Sci., 20(16): 3894.
  • 30. Garantziotis S., Brezina M., Castelnuovo P. et al. (2016) The role of hyaluronan in the pathobiology and treatment of respiratory disease. Am. J. Physiol. Lung Cell. Mol. Physiol., 310(9): L785–L795.
  • 32. Охотнікова О.М. (2019) Сучасні методи усунення бронхообструктивного синдрому у дітей. Здоров’я України. Педіатрія, 4(51): 51.
  • 33. Охотнікова О.М., Дуда Л.В. (2017) Обструктивний бронхіт — чи така проста ця патологія у дітей? Sovr. Рediatr., 6(86): 87–96.