In Reply We thank Tanguay-Rioux et al for their careful reading and response, which allows us to clarify some points of our study. First, given the burden of acute bronchiolitis in infants, a treatment reducing hospital admission even by few percentage points should not be neglected. However, as stated by Ralston,1 demonstrating a slight efficacy in the experimental conditions of a randomized clinical trial does not imply a clinical pertinence in daily practice. For example, in a randomized clinical trial, patients are enrolled based on rigorous criteria, while a much larger phenotype of patients will be met in daily practice. The same applies to where and how the treatment is delivered. This point associated with adverse effects, and the cost of hypertonic saline (HS) nebulizations makes the clinical utility of such treatment very unlikely.
Angoulvant F, Milcent K, Gajdos V. Hypertonic Saline and Acute Bronchiolitis—Reply. JAMA Pediatr. 2018;172(1):93–94. doi:10.1001/jamapediatrics.2017.3799
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