Clinical significance of deblocking of nasal breathing in infants and children of early age with acute respiratory viral infections: advantages of isotonic seawater solution

Authors

DOI:

https://doi.org/10.15574/SP.2024.137.84

Keywords:

children, acute respiratory viral infections, saline solutions

Abstract

Acute respiratory viral infections (ARVI) are an urgent problem in young children, which is due to their significant prevalence, they have a constant tendency to increase and occupy the first places in the structure of infectious diseases. Damage to the mucous membranes of the upper respiratory tract in children with ARVI lead to numerous problems that require adequate replacement of the main functions of the child’s body, which determined the relevance of our study.

Purpose - to analyze the effectiveness of the use of isotonic dilution of sea water (Pshyk Mini medicine) for irrigation therapy in nasal congestion in infants and young children caused by acute respiratory infections.

Materials and methods. A comprehensive examination of 100 infants and young children with influenza and other ARVI was conducted in the infectious diseases department of the Chernivtsi Regional Children’s Clinical Hospital. The children were randomly divided into 2 clinical groups: the Group I included 55 children (average age - 1.09±0.3 years, the proportion of boys - 58.1%), who, as part of complex standard therapy, received nasal irrigation using 2-3 drops of Pshyk mini medicine in each nostril 3 times/day. The Group II included 45 patients (average age - 1.15±0.2 years (p>0.05), the proportion of boys - 59.1% (p>0.05)), in whom isotonic sodium chloride solution was used for the purpose of the nasal sanitation.

Results. The conducted studies showed that starting from the 3-4th day of hospitalization, a statistically significant decrease in catarrhal manifestations and the severity of nasal obstruction was noted in patients of the Group I who received Pshyk Mini in complex treatment. In particular, in relation to the results of the Group II, in the children of the Group I, on the 4th day of inpatient treatment, the chances of reducing the severity of catarrhal manifestations (estimated ≤2 points) increased: the absolute risk increase - 53.0%, the relative risk increase - 67.9% (95% CI: 57.8-76.9) with the minimum number of patients who need to be treated to obtain a positive result - 1.5. We also established that compared to the representatives of the Group II, children of the Group I had almost a 4-fold increase in the chances of restoring tolerance to feeding (estimation of feeding difficulties ≤2 points): attributive risk - 30.5%, relative risk - 1.6 (95% CI: 0.6-4.8), odds ratio - 3.9 (95% CI: 1.2-12.3).

Conclusions. For the purpose of unblocking of nasal breathing in infants and children of early age at the background of acute respiratory viral infections, the use of an isotonic solution of sea water (Pshyk Mini medicine) has a number of significant advantages compared to the use of an isotonic solution of sodium chloride for this purpose.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

References

Abreu RR, Rocha RL, Lamounier JA, Guerra AF. (2008). Etiology, clinical manifestations and concurrent findings in mouth-breathing children. J Pediatr (Rio J). 84 (6): 529-535. https://doi.org/10.2223/JPED.1844; PMid:19060979

Alvo A, Villarroel G, Sedano C. (2021). Neonatal nasal obstruction. Eur Arch Otorhinolaryngol. 278 (10): 3605-3611. https://doi.org/10.1007/s00405-020-06546-y; PMid:33388986

Bahammam AS, Tate R, Manfreda J, Kryger MH. (1999). Upper airway resistance syndrome: effect of nasal dilation, sleep stage, and sleep position. Sleep. 22 (5): 592-598. https://doi.org/10.1093/sleep/22.6.740; PMid:10505819

Chen JR, Jin L, Li XY. (2014). The effectiveness of nasal saline irrigation (seawater) in treatment of allergic rhinitis in children. Int J Pediatr Otorhinolaryngol. 78 (7): 1115-1118. https://doi.org/10.1016/j.ijporl.2014.04.026; PMid:24809770

Chong LY, Head K, Hopkins C, Philpott C, Glew S, Scadding G et al. (2016). Saline irrigation for chronic rhinosinusitis. Cochrane Database Syst Rev. 4 (4): CD011995. https://doi.org/10.1002/14651858.CD011995.pub2; PMid:27115216

De Servi B, Meloni M, Saaid A, Culig J. (2020). In vitro Comparison of Safety and Efficacy of Diluted Isotonic Seawater and Electrodialyzed Seawater for Nasal Hygiene. Med Devices (Auckl). 13: 391-398. https://doi.org/10.2147/MDER.S285593; PMid:33312003 PMCid:PMC7726834

Gangadi M, Georgiou S, Moschotzopoulou E, Antronikou T, Kainis E, Alevizopoulos K. (2022). Efficacy and safety of a hypertonic seawater nasal irrigation solution containing algal and herbal natural ingredients in patients with COVID-19. Eur Rev Med Pharmacol Sci. 26; 2: 112-123. doi: 10.26355/eurrev_202212_30495.

Gentzsch M, Rossier BC. (2020). A Pathophysiological Model for COVID-19: Critical Importance of Transepithelial Sodium Transport upon Airway Infection. Function (Oxf). 1 (2): zqaa024. https://doi.org/10.1093/function/zqaa024; PMid:33201937 PMCid:PMC7662147

Grant SN, Lester HA. (2021). Regulation of epithelial sodium channel activity by SARS-CoV-1 and SARS-CoV-2 proteins. Biophys J. 120 (14): 2805-2813. https://doi.org/10.1016/j.bpj.2021.06.005; PMid:34197807 PMCid:PMC8238646

Huang S, Constant S, De Servi B, Meloni M, Saaid A, Culig J, Bertini M. (2021). Is a diluted seawater-based solution safe and effective on human nasal epithelium? Eur Arch Otorhinolaryngol. 278 (8): 2837-2842. https://doi.org/10.1007/s00405-020-06527-1; PMid:33392764 PMCid:PMC8266784

Huijghebaert S, Parviz S, Rabago D, Baxter A, Chatterjee U, Khan FR et al. (2023). Saline nasal irrigation and gargling in COVID-19: a multidisciplinary review of effects on viral load, mucosal dynamics, and patient outcomes. Front Public Health. 11: 1161881. https://doi.org/10.3389/fpubh.2023.1161881; PMid:37397736 PMCid:PMC10312243

King D. (2019, Apr). What role for saline nasal irrigation? Drug Ther Bull. 57 (4): 56-59. https://doi.org/10.1136/dtb.2018.000023; PMid:30858292

Leboulanger N. (2016, Jun). Nasal obstruction in children. Eur Ann Otorhinolaryngol Head Neck Dis. 133 (3): 183-186. https://doi.org/10.1016/j.anorl.2015.09.011; PMid:26471039

Lopes TS, Moura LF, Lima MC. (2014). Association between breastfeeding and breathing pattern in children: a sectional study. J Pediatr (Rio J). 90 (4): 396-402. https://doi.org/10.1016/j.jped.2013.12.011; PMid:24703820

Machado RRG, Glaser T, Araujo DB, Petiz LL, Oliveira DBL, Durigon GS et al. (2021). Inhibition of Severe Acute Respiratory Syndrome Coronavirus 2 Replication by Hypertonic Saline Solution in Lung and Kidney Epithelial Cells. ACS Pharmacol Transl Sci. 4 (5): 1514-1527. https://doi.org/10.1021/acsptsci.1c00080; PMid:34651104 PMCid:PMC8442612

Morais-Almeida M, Wandalsen GF, Solé D. (2019). Growth and mouth breathers. J Pediatr (Rio J). 95 (1): 66-71. https://doi.org/10.1016/j.jped.2018.11.005; PMid:30611649

Panta P, Chatti K, Andhavarapu A. (2021). Do saline water gargling and nasal irrigation confer protection against COVID-19? Explore (NY). 17 (2): 127-129. https://doi.org/10.1016/j.explore.2020.09.010; PMid:33046408 PMCid:PMC7528968

Pantazopoulos I, Chalkias A, Miziou A, Spanos M, Gerovasileiou E, Rouka E, Gourgoulianis K. (2023). A Hypertonic Seawater Nasal Irrigation Solution Containing Algal and Herbal Natural Ingredients Reduces Viral Load and SARS-CoV-2 Detection Time in the Nasal Cavity. J Pers Med. 13 (7): 1093. https://doi.org/10.3390/jpm13071093; PMid:37511706 PMCid:PMC10381905

Park EH, Kim JG, Yang YM, Jeon JG, Yoo JI, Kim JK, Lee DW. (2018). Association Between Breastfeeding and Childhood Breathing Patterns: A Systematic Review and Meta-Analysis. Breastfeed Med. 13 (4): 240-247. https://doi.org/10.1089/bfm.2017.0222; PMid:29608327

Ramalingam S, Cai B, Wong J, Twomey M, Chen R, Fu RM et al. (2018). Antiviral innate immune response in non-myeloid cells is augmented by chloride ions via an increase in intracellular hypochlorous acid levels. Sci Rep. 8 (1): 13630. https://doi.org/10.1038/s41598-018-31936-y; PMid:30206371 PMCid:PMC6134045

Ramalingam S, Graham C, Dove J, Morrice L, Sheikh A. (2020). Hypertonic saline nasal irrigation and gargling should be considered as a treatment option for COVID-19. J Glob Health. 10 (1): 010332. https://doi.org/10.7189/jogh.10.010332; PMid:32395245 PMCid:PMC7193539

Rogers TD, Ostrowski LE, Livraghi-Butrico A, Button B, Grubb BR. (2018). Mucociliary Clearance in Mice Measured by Tracking Trans-tracheal Fluorescence of Nasally Aerosolized Beads. Sci Rep. 8 (1): 14744. https://doi.org/10.1038/s41598-018-33053-2; PMid:30282981 PMCid:PMC6170422

Scadding G. (2008). Optimal management of nasal congestion caused by allergic rhinitis in children: safety and efficacy of medical treatments. Paediatr Drugs. 10 (3): 151-162. https://doi.org/10.2165/00148581-200810030-00004; PMid:18454568

Vitolo MR, Bortolini GA, Dal Bó Campagnolo P, Feldens CA. (2008, Oct). Effectiveness of a nutrition program in reducing symptoms of respiratory morbidity in children: a randomized field trial. Prev Med. 47 (4): 384-388. https://doi.org/10.1016/j.ypmed.2008.07.008; PMid:18675844

Published

2024-02-28

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Original articles