Nebulization Therapy in Pediatric Patients with Bronchiolitis: A Literature Review
DOI:
https://doi.org/10.32583/keperawatan.v16i2.1747Keywords:
bronchiolitis, combination therapy, nebulization, pediatric, therapyAbstract
Bronchiolitis is one of the most common causes of hospitalization in children under two years old. The main treatment for bronchiolitis is supportive therapy. Nebulization therapy in pediatric bronchiolitis is still being controversial in clinical practice and based on guideline recommendations. The purpose of this study is to determine and review the beneficial effects of saline and nebulized therapy in pediatric patients with bronchiolitis. Literature searches were obtained through reference sources from Google Scholar, PubMed, Proquest, JSTOR, ScienceDirect, and SAGE. Inclusion criteria were original articles, published in Indonesian and English, and assessed nebulization therapy's outcome in pediatric bronchiolitis patients. The treatment of administering nebulized saline NS or HS 3% can provide more effective results than treatment without nebulization. Many studies using nebulized salbutamol have found less clinical effectiveness and resulted in longer hospital stays. Combination therapy of saline and nebulization has more effective clinical results than single therapy of saline or nebulized drugs.
References
Akshatha, K., Sunita, & Shree, S. (2022). The clinical efficacy of combined nebulized adrenaline with injection dexamethasone versus 3% normal saline (3%NS) nebulization in acute bronchiolitis. European Journal of Molecular & Clinical Medicine, 9(2), 2353–2358.
Alharbi, A., Alqwaiee, M., Al-Hindi, M., Mosalli, R., Al-Shamrani, A., Alharbi, S., Yousef, A., Al Aidaroos, A., Alahmadi, T., Alshammary, A., Miqdad, A., Said, Y., & Alnemri, A. (2018). Bronchiolitis in children: The Saudi-initiative of bronchiolitis diagnosis, management, and prevention (SIBRO). In Annals of Thoracic Medicine (Vol. 13, Issue 3, pp. 127–143). Wolters Kluwer Medknow Publications. https://doi.org/10.4103/atm.ATM_60_18
Ali, A., Naeem, H. M. M., Rafique, A., Hussain, S., Rasheed, M., & Uzair, M. (2022). Comparison of Hypertonic Saline vs Salbutamol in Normal Saline Nebulization in Children with Bronchiolitis. Pakistan Journal of Medical and Health Sciences, 16(10), 796–803. https://doi.org/10.53350/pjmhs221610796
Angoulvant, F., Bellêttre, X., Milcent, K., Teglas, J. P., Claudet, I., Le Guen, C. G., De Pontual, L., Minodier, P., Dubos, F., Brouard, J., Soussan-Banini, V., Degas-Bussiere, V., Gatin, A., Schweitzer, C., Epaud, R., Ryckewaert, A., Cros, P., Marot, Y., Flahaut, P., … Gajdos, V. (2017). Effect of nebulized hypertonic saline treatment in emergency departments on the hospitalization rate for acute bronchiolitis: A randomized clinical trial. JAMA Pediatrics, 171(8). https://doi.org/10.1001/jamapediatrics.2017.1333
Bakalović, G., Jarkoč, T., Begić, N., Lepara, O., Bokonjić, D., Mihajlović, D., Pasić, A., & Fajkić, A. (2023). Efficacy of nebulized hypertonic saline versus normal saline in the treatment of acute bronchiolitis in inpatient infants. Medicinski Glasnik, 20(2), 169–174. https://doi.org/10.17392/1560-23
Bawazeer, M., Aljeraisy, M., Albanyan, E., Abdullah, A., Thaqafi, W. Al, Alenazi, J., otaibi, Z. Al, & Ghaihab, M. Al. (2014). Effect of combined dexamethasone therapy with nebulized r-epinephrine or salbutamol in infants with bronchiolitis: A randomized, double-blind, controlled trial. Avicenna Journal of Medicine, 04(03), 58–65. https://doi.org/10.4103/2231-0770.133333
Beal, G., Barbier, C., Thoret, S., Rubio, A., Bonnet, M., Mazet, R., Ego, A., & Pin, I. (2019). Nebulized hypertonic saline 3% for 1 versus 3 days in hospitalized bronchiolitis: A blinded non-inferiority randomized controlled trial. BMC Pediatrics, 19(1). https://doi.org/10.1186/s12887-019-1804-0
Bradley, J. P., Bacharier, L. B., Bonfiglio, J. A., Schechtman, K. B., Strunk, R., Storch, G., & Castro, M. (2005). Severity of respiratory syncytial virus bronchiolitis is affected by cigarette smoke exposure and atopy. Pediatrics, 115(1). https://doi.org/10.1542/peds.2004-0059
Chen, L., Shi, M., Deng, Q., Liu, W., Li, Q., Ye, P., Yu, X., Zhang, B., Xu, Y., Li, X., Yang, Y., Li, M., Yan, Y., Xu, Z., Yu, J., Xiang, L., Tang, X., Wan, G., Cai, Q., … Liu, H. (2020). A multi-center randomized prospective study on the treatment of infant bronchiolitis with interferon α1b nebulization. PLoS ONE, 15(2). https://doi.org/10.1371/journal.pone.0228391
Crow, R., Mutyara, K., Agustian, D., Kartasasmita, C. B., & Simões, E. A. F. (2021). Risk factors for respiratory syncytial virus lower respiratory tract infections: Evidence from an indonesian cohort. Viruses, 13(2). https://doi.org/10.3390/v13020331
Danish, A. I., Humayoun, Q. S., Shabbir, A., Liaquat, I., Hafeez, M., & . I. (2022a). Comparison of Efficacy of Epinephrine to Salbutamol and Ipratropium Bromide Combined in Acute Bronchiolitis. Pakistan Journal of Medical and Health Sciences, 16(5), 1024–1026. https://doi.org/10.53350/pjmhs221651024
Danish, A. I., Humayoun, Q. S., Shabbir, A., Liaquat, I., Hafeez, M., & . I. (2022b). Comparison of Efficacy of Epinephrine to Salbutamol and Ipratropium Bromide Combined in Acute Bronchiolitis. Pakistan Journal of Medical and Health Sciences, 16(5), 1024–1026. https://doi.org/10.53350/pjmhs221651024
Debbarma, R., Khera, D., Singh, S., Toteja, N., Choudhary, B., & Singh, K. (2021). Nebulized Magnesium Sulphate in Bronchiolitis: A Randomized Controlled Trial. Indian Journal of Pediatrics, 88(11), 1080–1085. https://doi.org/10.1007/s12098-021-03695-8
Erickson, E., Bhakta, R., & Mendez, M. (2023). Pediatric Bronchiolitis. Treasure Island (FL): StatPearls Publishing.
Flores, P., Mendes, A. L., & Neto, A. S. (2016). A randomized trial of nebulized 3% hypertonic saline with salbutamol in the treatment of acute bronchiolitis in hospitalized infants. Pediatric Pulmonology, 51(4), 418–425. https://doi.org/10.1002/ppul.23306
Flores-González, J. C., Matamala-Morillo, M. A., Rodríguez-Campoy, P., Pérez-Guerrero, J. J., Serrano-Moyano, B., Comino-Vazquez, P., Palma-Zambrano, E., Bulo-Concellón, R., Santos-Sánchez, V., Lechuga-Sancho, A. M., Contreras, A. A., Ramírez, M. A., Coronel, M. T. D., Cerrato, P. J., Ortega, R. G., García, L. G., Corrales, F. J. D., Zambrana, E. P., & Vázquez, P. C. (2015). Epinephrine improves the efficacy of nebulized hypertonic saline in moderate bronchiolitis: A randomised clinical trial. PLoS ONE, 10(11). https://doi.org/10.1371/journal.pone.0142847
Friedman, J., Rieder, M., & Walton, J. (n.d.). Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age. https://doi.org/10.1093/pch/19.9.485
Giudice, M., Saitta, F., & Leonardi, S. (2012). Effectiveness of Nebulized Hypertonic Saline and Epinephrine in Hospitalized Infants with Bronchiolitis. International Journal of Immunopathology and Pharmacology, 25(2), 485–491. https://doi.org/10.1177/039463201202500218
Guitart, C., Alejandre, C., Torrús, I., Balaguer, M., Esteban, E., Cambra, F. J., & Jordan, I. (2021). Impact of a modification of the clinical practice guide of the American Academy of Pediatrics in the management of severe acute bronchiolitis in a pediatric intensive care unit. Medicina Intensiva, 45(5), 289–297. https://doi.org/10.1016/j.medin.2019.10.006
Gupta, H., Gupta, V., Kaur, G., Baidwan, A., George, P., Shah, J., Shinde, K., Malik, R., Chitkara, N., & Bajaj, K. (2016). Effectiveness of 3% hypertonic saline nebulization in acute bronchiolitis among Indian children: A quasi-experimental study. Perspectives in Clinical Research, 7(2), 88. https://doi.org/10.4103/2229-3485.179434
Hassan, S., Gonzalez, A., Demissie, S., Morawakkoralage, K., & James, P. (2018). Nebulized Normal Saline Solution for Treatment of Bronchial Asthma Exacerbations and Bronchiolitis: Not Standard of Care. Clinical Pediatrics, 57(13), 1582–1587. https://doi.org/10.1177/0009922818796657
Ibrahim, M., Verma, R., & Garcia-Contreras, L. (2015). Inhalation drug delivery devices: Technology update. In Medical Devices: Evidence and Research (Vol. 8, pp. 131–139). Dove Medical Press Ltd. https://doi.org/10.2147/MDER.S48888
Joshi, M., Majagaiya, B., Cheng, H.-J., Yin, J.-N., & Chaudhary, M. (2022). Outcome of treatment with nebulized 3% hypertonic saline solution in infants hospitalized with moderate bronchiolitis. International Journal of Pregnancy & Child Birth, 8(2), 42–46. https://doi.org/10.15406/ipcb.2022.08.00259
Luo, Z., Fu, Z., Liu, E., Xu, X., Fu, X., Peng, D., Liu, Y., Li, S., Zeng, F., & Yang, X. (2011). Nebulized hypertonic saline treatment in hospitalized children with moderate to severe viral bronchiolitis. Clinical Microbiology and Infection, 17(12), 1829–1833. https://doi.org/10.1111/j.1469-0691.2010.03304.x
Manti, S., Staiano, A., Orfeo, L., Midulla, F., Marseglia, G. L., Ghizzi, C., Zampogna, S., Carnielli, V. P., Favilli, S., Ruggieri, M., Perri, D., Di Mauro, G., Gattinara, G. C., D’Avino, A., Becherucci, P., Prete, A., Zampino, G., Lanari, M., Biban, P., … Baraldi, E. (2023). UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants. In Italian Journal of Pediatrics (Vol. 49, Issue 1). BioMed Central Ltd. https://doi.org/10.1186/s13052-022-01392-6
Mojtaba, K., Fardin, A., Ali Naghi, K., Koorosh, K., & Elham, E. (2016). The priority of using hypertonic saline over ventolin in the treatment of bronchiolitis. Journal of Health Research and Reviews, 3(3), 98. https://doi.org/10.4103/2394-2010.193180
Mull, C. C., Scarfone, R. J., Ferri, L. R., Carlin, T., Salvaggio, C., Bechtel, K. A., Ann, M., Trephan, H., Rissman, R. L., & Gracely, E. J. (2004). A Randomized Trial of Nebulized Epinephrine vs Albuterol in the Emergency Department Treatment of Bronchiolitis. In Arch Pediatr Adolesc Med (Vol. 158). http://archpedi.jamanetwork.com/
Naz F, Raza AB, Ijaz I, Kazi MY. Effectiveness of nebulized N-acetylcysteine solution in children with acute bronchiolitis. J Coll Physicians Surg Pak. 2014 Jun;24(6):408-11.
O’Brien, S., Borland, M. L., Cotterell, E., Armstrong, D., Babl, F., Bauert, P., Brabyn, C., Garside, L., Haskell, L., Levitt, D., McKay, N., Neutze, J., Schibler, A., Sinn, K., Spencer, J., Stevens, H., Thomas, D., Zhang, M., Oakley, E., & Dalziel, S. R. (2019). Australasian bronchiolitis guideline. Journal of Paediatrics and Child Health, 55(1), 42–53. https://doi.org/10.1111/jpc.14104
Özlem Şimşek-Kiper, P., Kiper, N., Hasçelik, G., Dolgun, A., Yalçın, E., Doğru-Ersöz, D., & Özçelik, U. (2011). Emergency room management of acute bronchiolitis: a randomized trial of nebulized epinephrine. In The Turkish Journal of Pediatrics (Vol. 53).
Pinto, J. M., Schairer, J. L., & Petrova, A. (2016). Duration of Hospitalization in Association with Type of Inhalation Therapy Used in the Management of Children with Nonsevere, Acute Bronchiolitis. Pediatrics and Neonatology, 57(2), 140–144. https://doi.org/10.1016/j.pedneo.2015.04.014
Plint, A. C., Johnson, D. W., Patel, H., Wiebe, N., Math, M., Correll, R., Brant, R., Mitton, C., Gouin, S., Bhatt, M., Joubert, G., Black, K. J. L., Turner, T., Whitehouse, S., & Klassen, T. P. (2009). Epinephrine and Dexamethasone in Children with Bronchiolitis A BS TR AC T. In N Engl J Med (Vol. 360).
Pukai, G., & Duke, T. (2020). Nebulised normal saline in moderate acute bronchiolitis and pneumonia in a low- to middle-income country: a randomised trial in Papua New Guinea. Paediatrics and International Child Health, 40(3), 171–176. https://doi.org/10.1080/20469047.2020.1725338
Ralston, S. L., Lieberthal, A. S., Meissner, H. C., Alverson, B. K., Baley, J. E., Gadomski, A. M., Johnson, D. W., Light, M. J., Maraqa, N. F., Mendonca, E. A., Phelan, K. J., Zorc, J. J., Stanko-Lopp, D., Brown, M. A., Nathanson, I., Rosenblum, E., Sayles, S., & Hernandez-Cancio, S. (2014). Clinical practice guideline: The diagnosis, management, and prevention of bronchiolitis. In Pediatrics (Vol. 134, Issue 5, pp. e1474–e1502). American Academy of Pediatrics. https://doi.org/10.1542/peds.2014-2742
Sapkota, S., Kaleem, A., Huma, S., Aleem Ud Din, M., Ahmad, S., & ShahAlam, S. (2021). Comparison of 3% saline and 0.9% normal saline nebulization as diluent in children with bronchiolitis. The Journal of the Pakistan Medical Association, 71(3), 822–825. https://doi.org/10.47391/JPMA.569
Sharma, B. S., Gupta, M. K., & Rafik, S. P. (2013). Hypertonic (3%) saline vs 0.93% saline nebulization for acute viral bronchiolitis: a randomized controlled trial. Indian Pediatrics, 50(8), 743–747. https://doi.org/10.1007/s13312-013-0216-8
Silver, A. H., Esteban-Cruciani, N., Azzarone, G., Douglas, L. C., Lee, D. S., Liewehr, S., Nazif, J. M., Agalliu, I., Villegas, S., Rhim, H. J. H., Rinke, M. L., & O’Connor, K. (2015). 3% Hypertonic saline versus normal saline in inpatient bronchiolitis: A randomized controlled trial. Pediatrics, 136(6), 1036–1043. https://doi.org/10.1542/peds.2015-1037
Singh, S., Hornick, D., Fedler, J., Launspach, J. L., Teresi, M. E., Santacroce, T. R., Cavanaugh, J. E., Horan, R., Nelson, G., Starner, T. D., Zabner, J., & Durairaj, L. (2020). Randomized controlled study of aerosolized hypertonic xylitol versus hypertonic saline in hospitalized patients with pulmonary exacerbation of cystic fibrosis. Journal of Cystic Fibrosis, 19(1), 108–113. https://doi.org/10.1016/j.jcf.2019.06.016
Skjerven, H. O., Rolfsjord, L. B., Berents, T. L., Engen, H., Dizdarevic, E., Midgaard, C., Kvenshagen, B., Aas, M. H., Hunderi, J. O. G., Stensby Bains, K. E., Mowinckel, P., Carlsen, K. H., & Lødrup Carlsen, K. C. (2015). Allergic diseases and the effect of inhaled epinephrine in children with acute bronchiolitis: Follow-up from the randomised, controlled, double-blind, Bronchiolitis ALL trial. The Lancet Respiratory Medicine, 3(9), 702–708. https://doi.org/10.1016/S2213-2600(15)00319-7
Song, Y., & Li, R. (2021). Effect of budesonide combined with salbutamol nebulization on pulmonary function and serum immune factors in children with bronchiolitis. In Am J Transl Res (Vol. 13, Issue 7). www.ajtr.org
Stokes, G. M., Milner, A. D., Hodges, G. C., Henry, R. L., & Elphick, M. C. (1983). Nebulised therapy in acute severe bronchiolitis in infancy. In Archives of Disease in Childhood.
Teeratakulpisarn, J., Pientong, C., Ekalaksananan, T., Ruangsiripiyakul, H., & Uppala, R. (2014). Rhinovirus infection in children hospitalized with acute bronchiolitis and its impact on subsequent wheezing or asthma: A comparison of etiologies. Asian Pacific Journal of Allergy and Immunology, 32(3), 226–234. https://doi.org/10.12932/AP0417.32.3.2014
Teunissen, J., Hochs, A. H. J., Vaessen-Verberne, A., Boehmer, A. L. M., Smeets, C. C. J. M., Brackel, H., Van Gent, R., Wesseling, J., Logtens-Stevens, D., De Moor, R., Rosias, P. P. R., Potgieter, S., Faber, M. R., Hendriks, H. J. E., Janssen-Heijnen, M. L. G., & Loza, B. F. (2014). The effect of 3% and 6% hypertonic saline in viral bronchiolitis: A randomised controlled trial. European Respiratory Journal, 44(4), 913–921. https://doi.org/10.1183/09031936.00159613
Thorburn, K., & McNamara, P. S. (2014). Bronchiolitis. In Pediatric Critical Care Medicine: Volume 2: Respiratory, Cardiovascular and Central Nervous Systems (pp. 75–85). Springer-Verlag London Ltd. https://doi.org/10.1007/978-1-4471-6356-5_5
Tinsa, F., Rhouma, A. Ben, Ghaffari, H., Boussetta, K., Zouari, B., Brini, I., Karboul, L., Souid, M., & Bousnina, S. (2009). A Randomized, Controlled Trial of Nebulized Terbutaline in the First Acute Bronchiolitis in Infant Less Than 12 Months Old. La Tunisie Medicale (Vol. 87, Issue n°03).
Uysalol, M., Haşlak, F., Özünal, Z. G., Vehid, H., & Uzel, N. (2017). Rational drug use for acute bronchiolitis in emergency care. Turkish Journal of Pediatrics, 59(2), 155–161. https://doi.org/10.24953/turkjped.2017.02.007
Wainwright, C., Altamirano, L., Cheney, M., Cheney, J., Barber, S., Price, D., Moloney, S., Kimberley, A., Woolfield, N., Cadzow, S., Fiumara, F., Wilson, P., Mego, S., VandeVelde, D., Sanders, S., Francis, P., Coast Hospital, G., Coast, G. D., Moloney, S., … Hospi-tal, R. (2003). A Multicenter, Randomized, Double-Blind, Controlled Trial of Nebulized Epinephrine in Infants with Acute Bronchiolitis. In n engl j med (Vol. 349).
Wu, S. H., Chen, X. Q., Kong, X., Yin, P. L., Dong, L., Liao, P. Y., & Wu, J. M. (2016). Characteristics of respiratory syncytial virus-induced bronchiolitis co-infection with Mycoplasma pneumoniae and add-on therapy with montelukast. World Journal of Pediatrics, 12(1), 88–95. https://doi.org/10.1007/s12519-015-0024-4
Yasin, F., Afridi, Z. S., Mahmood, Q., Khan, A. A., Condon, S., & Khan, R. A. (2021). Role of nebulized epinephrine in moderate bronchiolitis: a quasi-randomized trial. Irish Journal of Medical Science, 190(1), 239–242. https://doi.org/10.1007/s11845-020-02293-5
Zhang, L., Mendoza-Sassi, R. A., Wainwright, C., & Klassen, T. P. (2017). Nebulised hypertonic saline solution for acute bronchiolitis in infants. In Cochrane Database of Systematic Reviews (Vol. 2017, Issue 12). John Wiley and Sons Ltd. https://doi.org/10.1002/14651858.CD006458.pub4
Zhao, X. (2019). Expert consensus on nebulization therapy in pre-hospital and in-hospital emergency care. Annals of Translational Medicine, 7(18), 487–487. https://doi.org/10.21037/atm.2019.09.44
Zhou, Q., Chen, V., Shannon, C. P., Wei, X., Xiang, X., Wang, Z., Tebbutt, S. J., Kollmann, T. R., & Fish, E. N. (2020). Interferon- α 2b treatment for COVID-19. 1–21.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Jurnal Keperawatan
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
