Al‐Ansari 2010.

Methods	Design: randomised, double‐blind, parallel‐group, controlled trial
Participants	Setting: paediatric emergency facility in Qatar Assessed for eligibility: 187 Randomised: 115 hypertonic saline group (5% saline: 57; 3% saline: 58); 56 normal saline group Completed: 115 hypertonic saline group; 56 normal saline group Gender (male): 59.1% Age (mean ± SD): 3.8 ± 2.8 months in 3% saline group; 4.0 ± 2.5 months in 5% saline group; 3.3 ± 2.4 months in normal saline group Inclusion criteria: infants aged ≤ 18 months, with a prodromal history of viral upper respiratory tract infection, followed by wheezing or crackles, or both on auscultation and Wang clinical severity score ≥ 4 Exclusion criteria: born at ≤ 34 weeks’ gestation, previous history of wheezing, steroid use within 48 h of presentation, obtundation and progressive respiratory failure requiring ICU admission, history of apnoea within 24 hours before presentation, SaO₂ ≤ 85% on room air at the time of recruitment, history of a diagnosis of chronic lung disease, congenital heart disease, or immunodeficiency
Interventions	Intervention groups: Group 1: nebulised 5% hypertonic saline (5 mL) plus 1.5 mL of epinephrine Group 2: nebulised 3% hypertonic saline (5 mL) plus 1.5 mL of epinephrine Control group: nebulised 0.9% normal saline (5 mL) plus 1.5 mL of epinephrine Treatment was given every 4 hours, until the patient was ready for discharge. Nebulised medications were delivered through a tight‐fitting face mask by pressurised oxygen with the flow meter set at 10 L/min.
Outcomes	Wang clinical severity score Oxygen saturation Length of stay Need for ICU admission Rate of re‐admission Adverse events
Notes	Virological identification not available
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐based randomisation program
Allocation concealment (selection bias)	Low risk	Sequentially numbered and sealed envelopes
Blinding (performance bias and detection bias) All outcomes	Low risk	Double‐blind
Incomplete outcome data (attrition bias) All outcomes	Low risk	16 (9.3%) withdrawals after randomisation; baseline characteristics between treatment groups were balanced.
Selective reporting (reporting bias)	Low risk	All predefined outcomes reported.
Other bias	Low risk	No other bias found.