High-dose Inhaled Nitric Oxide Revealed As Potential Treatment for Pediatric Bronchiolitis

High-dose Inhaled Nitric Oxide Revealed As Potential Treatment for Pediatric Bronchiolitis

Hospitalized children with bronchiolitis, an acute inflammation of the bronchioles usually caused by a viral infection, treated with intermittent high-dose inhaled nitric oxide exhibit potentially better outcomes when compared to standard oxygen therapy. These findings are the result of data recently presented at the American Thoracic Society International Conference by Asher Tal, MD.

Tal and colleagues of Advanced Inhalation Therapies performed a double blind, randomized study with 43 children (aged from 2 to 12 months) to determine both safety and tolerability of intermittent high-dose inhaled NO as a strategy to treat children with bronchiolitis. Of the initial pool of 43 children, 25 of those were hospitalized for more than 24 hours and were evaluated for NO inhalation efficacy – 14 children received intermittent high-dose inhaled NO while 11 received oxygen. While no differences were observed between both groups for adverse events, children treated with NO therapy remained in the hospital for a significantly shorter period, when compared to those on oxygen. Specifically, while the NO group remained hospitalized for an average of 46 hours, the oxygen group was in the hospital for 74 hours. Additionally, the NO group reached 92% of oxygen saturation much faster, when compared to the oxygen group – 26 hours versus 61 hours, respectively.

While the study didn’t address directly treatments efficacy in patients outcomes, the preliminary data suggests intermittent high-dose inhaled NO is a potential treatment for children with bronchiolitis. 

Dr. Av-Gay, professor of the division of infectious diseases at the University of British Columbia, Vancouver and Advanced Inhalation Therapies chief scientific officer commented, “Nitric oxide gas is used to treat neonates at lower dose, and in this study we investigated its antimicrobial dosage, which is higher than current treatment. Previous in-vitro and in animal studies support the antimicrobial effect of intermittent inhalations of 160 ppm of NO to treat lower respiratory tract infections, both viral and bacterial. Bronchiolitis is a viral-related [infection] that causes significant morbidity and even mortality in infants around the world. Presently the treatment protocol for hospitalized infants is supportive care only, because despite many years of research as there is not yet an available treatment or specific anti-viral drug. Inhaled NO is thus an exciting potential novel drug for the treatment of acute bronchiolitis.”

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