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• 4 year• 2nd wheezy episode• O/E mild distress . Sats borderline • Management :
Salbutamol
Ipratropium bromide
Steroid
Hypertonic Saline and Acute Wheezing in Preschool Children
PediatricsVol 129 6 June 2012 .On line May 2012
Background • Rhinovirus - common cause of lower airway
inflammation
• Change in electrolyte and water movement on the luminal surface of epithelial cells similar to RSV infection increases ATPase leading to decrease ATP level
• This decreases electrolyte movement and dehydration at luminal level
CLINICAL QUESTION Population Preschool children
Intervention 5% Hypertonic saline
Comparison Placebo
Outcome Reduce hospitalisation and duration of stay
Design Randomised double blind controlled trial
Methods • A prospective, randomized double-blind controlled trial to
investigate the efficacy of inhaled HS treatment of 1to 6-year-old children presented to the ED with acute wheezing episodes from January 2009 to January 2011
• Inclusion criteria were children aged 1to 6 years who presented with acute wheezing illness and a CS ≥6
• During RSV season, 2 to 6-year-old children were recruited to exclude infants with RSV bronchiolitis
Asthma Clinical Severity ScoreModified from Qureshi et al.
1 Point 2 Point 3 Point
Respiratory rate (breath/min)
2–3 yr ≤34 35-39 ≤40
4–5 y ≤30 31-35 ≤36
Oxygen saturation (%), room air
>95 90-95 <90
Auscultation Normal or end-expiratory wheezing Expiratory wheezing Intercostals, substernal and
supraclavicular Retractions Non or intercostals
Intercostals and substernal Intercostals, substernal and supraclavicular
Dyspnea Speaks in sentences or coos and babbles
Speaks in partial sentences
or utters short cries Speaks in single words or short phrases or grunts
A/ Are the results of the trial valid?
Screening Questions
1 Did the trial address a clearly focused issue?
Yes Can't tell No
3 Were all of the patients who entered the trial properly accounted for at its conclusion
Yes Can't tell No
• Were patients analysed in the groups to which they were randomised?
Yes Can't tell No
Detailed Questions
4 Were patients, health workers and study personnel ‘blind’ to treatment?
Yes Can't tell No
Epidemiologic CharacteristicsHS n = 16 NS n = 25 All N = 41 P
Age (mo) 30 ± 13.4 19.7 ± 33.1 17.4 ±3 1.9 .6
Gender (female/male) 9:7 19:6 28:13 .3
Parent with asthma 37.5% 40% 39% 1.0
Atopic dermatitis 18.8% 8% 12.2% .35
Wheezing in the past 75% 84% 80.5% .7
Multiple-trigger past wheezing 43.8% 48% 46.3% 1.0
Age of first wheeze (mo) 9.4 ± 9.2 13.4 ± 12.3 11.7 ± 11 .482
Number of ED visits past year ± 0.751.1 0.88 ± 1 0.82 ± 1 1.0
Smoking in the family 68.8% 52% 58.5% .34
Kaplan-Meier graph for length of stay.
Ater D et al. Pediatrics 2012;129:e1397-e1403
©2012 by American Academy of Pediatrics