July 4, 2012Volume 7 - Issue 27  

DynaMed Weekly Update

For the week ending June 29, 2012

Last week 258 articles were evaluated via DynaMed's Systematic Literature Surveillance and 140 were added to DynaMed content.   


Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Nebulized Albuterol in Hypertonic Saline Rather than Normal Saline May Reduce Hospitalizations in Young Children with Acute Wheezing  


Virus-induced wheezing is a common cause of emergency department (ED) visits for young children, and symptoms often do not respond to bronchodilators and corticosteroids (N Engl J Med 2009 Jan 22;360(4):339,  N Engl J Med 2009 Jan 22;360(4):329).  There is previous evidence that nebulized hypertonic saline either alone or mixed with epinephrine may improve outcomes in infants with bronchiolitis (Cochrane Database Syst Rev 2011 Mar 16;(3):CD006458, J Pediatr 2010 Oct;157(4):630).  A new small randomized trial evaluated the effects of adding hypertonic saline to albuterol in 41 children aged 1-6 years visiting the ED with acute wheezing episodes.  Following a single inhalation of albuterol with normal saline, children were randomized to albuterol mixed with hypertonic saline 5% vs. albuterol mixed with normal saline.  The study drug was given twice in the ED with 20 minutes between doses and then 4 times daily if the child was admitted to the hospital.  Children with viral bronchiolitis were excluded.


Albuterol with hypertonic saline was associated with a significant reduction in hospital admission compared to albuterol plus normal saline (62.2% vs. 92%, p < 0.05, NNT 4)  The median hospital stay was 2 days with hypertonic saline vs. 3 days with normal saline (p = 0.027).  Clinical severity scores were significantly reduced in both groups compared to baseline, with no significant differences between groups (Pediatrics 2012 Jun;129(6):e1397).


For more information, see the Acute Bronchitis topic in DynaMed.

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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: July 4, 2012
Expiration Date: July 4, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
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AAFPEnduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each Weekly Update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


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Program ID:1102072R. 

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