Avoiding the use of an ineffective treatment in babies with acute bronchiolitis
Acute bronchiolitis is a condition that can cause breathing difficulties and is the most common cause of hospitalisation in babies. Many treatments have been tested, including steroids and antiviral agents, and have been found not to improve this illness or the amount of time required in hospital.
Study
Before we undertook this trial, one possible new treatment was hypertonic saline (also known as salt water). This treatment involved babies that were in hospital with this condition breathing in salt water through a fine mist, using a nebuliser.
Several small studies had been undertaken and suggested that salt water may reduce the seriousness of acute bronchiolitis and the amount of time required in hospital, but these studies differed in the way they were undertaken, meaning that no concrete recommendation could be made regarding whether this treatment should be used.
Results
Between 2011 and 2013, the SABRE trial (Saline in Acute Bronchiolitis Randomised controlled trial (RCT) and economic evaluation) was undertaken, led by Professor Mark Everard and the Sheffield Clinical Trials Research Unit.
317 babies with acute bronchiolitis who had been admitted to hospital took part in the trial from across the UK. Half of the babies received salt water (plus standard care), and the other half received standard care (and no salt water). We found that salt water did not reduce the amount of time the baby had to stay in hospital and we were unable to demonstrate any benefit from its use.
Impact
Following the publication of the results from the trial in Thorax, guidelines for the treatment of babies with acute bronchiolitis have been updated across the world to stipulate that salt water should not be provided to babies with acute bronchiolitis, including in the UK, France, Canada and Australasia. This has prevented babies from receiving this unnecessary and ineffective treatment.
Professor Mark Everard commented that "having one’s young baby admitted to hospital struggling to breathe is a very frightening experience for parents. Adding in a that can distress the baby further adds to the parent's distress and could only be justified if it made a dramatic difference. This study showed clearly that the treatment made no difference to how quickly the babies recovered and to how long they spent in hospital.
"This is a win-win result in that it saved babies from undergoing potentially distressing and ineffectual treatment, while at the same time, it prevented the waste of money and nursing time that would result if the treatment had been widely adopted as some had advocated."