TY - JOUR T1 - Hypertonic saline for acute viral bronchiolitis: take the evidence with a grain of salt JF - European Respiratory Journal JO - Eur Respir J SP - 827 LP - 830 DO - 10.1183/09031936.00129914 VL - 44 IS - 4 AU - Jürg Barben AU - Claudia E. Kuehni Y1 - 2014/10/01 UR - http://erj.ersjournals.com/content/44/4/827.abstract N2 - Fifty years ago, Reynolds and Cook [1] wrote, “Oxygen is vitally important in bronchiolitis and there is little convincing evidence that any other therapy is consistently or even occasionally useful.” Their claim is once again supported by the new trial on hypertonic saline published in this issue of the European Respiratory Journal (ERJ) [2].Acute viral bronchiolitis (AVB) is the most common lower respiratory tract infection in infancy. It is caused by respiratory viruses, typically by respiratory syncytial virus [3]. Although only 1–2% of children are hospitalised, AVB accounts for a large proportion of paediatric emergency visits and hospitalisations during winter months [4]. An effective treatment would reduce the number of hospitalisations, hospital length of stay (LOS) and their corresponding health costs.Over the past half century, no therapy for AVB has shown a convincing effect, though many have been tested. Among those treatments ruled out are β2-agonists, anticholinergics, inhaled or oral corticosteroids and chest physiotherapy [5–8]. Adrenaline might slightly improve short-term outcomes in outpatients but does not seem to reduce LOS in in-patients [9]. Current management recommendations and guidelines thus focus on supportive treatment with supplemental oxygen, fluid management, nasal douche with normal saline and/or nasal decongestants and respiratory support as needed, and avoiding unnecessary handling [10–14].Recently, studies have investigated the effectiveness of nebulised hypertonic saline. The first results looked promising [15–18]. A Cochrane review, which included papers indexed in medical databases until May 2013 [15–25], concluded that nebulised 3% hypertonic saline may reduce LOS among infants with nonsevere acute bronchiolitis, and improves clinical severity scores among in- and outpatients [26]. Unfortunately, the studies included in … ER -