Short‐term efficacy of ultrasonically nebulized hypertonic saline in cystic fibrosis

Abstract

Progressive lung disease in patients with cystic fibrosis (CF) is caused by thick secretions, which cause airway obstruction and subsequent colonization and infection by inhaled pathogenic microorganisms. Recently, recombinant human DNase has been shown to reduce the viscoelasticity of sputum in patients with cystic fibrosis and to improve lung function. Ultrasonically nebulized hypertonic saline (HS) has been demonstrated to enhance mucociliary clearance and sputum expectoration by rehydrating airway secretions, and may therefore provide a low cost alternative. We studied the changes in pulmonaty function and symptoms in a group of patients with CF who have moderate to severe lung disease. The patients were evaluated following 2 weeks of treatment with HS in an open-label study. Subjects were randomly allocated to receive 10 ml of either 0.9% NaCl (IS) or 6% NaCl (HS). Twice daily, prior to physiotherapy, treatments were delivered by a portable ultrasonic nebulizer. To prevent bronchoconstriction, 600 mg of salbutamol was administered prior to the nebulized solutions. A symptom score was recorded and spirometty was performed on day 0 before therapy was started, on day 14 (the last day of therapy), and on day 28 (14 days after the last treatment with either I S or HS). Fiity-two patients (32 males), with a mean age of 16.2 (range 7-36) years completed the study. There was no difference in baseline characteristics between the two groups. Following 2 weeks of treatment, there was a significant improvement from baseline in FEV, of 15.0 2 16.0% (mean 2 SD) in patients treated with HS, compared with a change of 2.8 2 13% in those on IS therapy (P = 0.004). Furthermore, there was a subjective improvement in the effectiveness of chest physiotherapy as reported by those using HS (P = 0.02). The treatment was well tolerated. We concludethat in patients with CF, ultrasonically nebulized hypertonicsaline improves lung function in a way similar to that reported for human recombinant DNase when inhaled over a 2 week period. Nebulized saline also enhances the perception of effectiveness of chest physiotherapy. Pediatr Pulmonol. 1996; 21 5'7-83. B 19% Wiley-Liss, Inc.

The Role of Seawater and Saline Solutions in Treatment of Respiratory Conditions

“…These results, which show a beneficiary effect of hypertonic saline, but much smaller or completely absent effect of isotonic saline, are confirmed by other authors [25][26][27][28]. Same effects of hypertonic saline were shown for mucociliary clearance in asthmatic patients [29], subjects with cystic fibrosis [30][31][32], children with bronchiolitis [33] and healthy subjects [15]. On the molecular level, this effect seems to be based on the upregulation by the hypertonic saline of the CLC-3, a chloride channel that accounts for the transport of chloride ions in numerous tissues and plays a fundamental role in transepithelial salt and water movement [34].…”

Nebulised 7% hypertonic saline improves lung function and quality of life in bronchiectasis

“…In patients with cystic fibrosis (15 adults and 43 children), 6% HS was shown to increase FEV 1 and sputum expectoration, over a 2 week period, when compared to IS. 16 A subjective improvement in the ease of performing chest physiotherapy following HS was also reported.…”

Airway Clearance Strategies in Cystic Fibrosis and Non-Cystic Fibrosis Bronchiectasis

“…143,145 Significant improvements in lung function, HRQOL, and ease of expectoration with short-and long-term use of HTS have been reported in individuals with CF aged 6 years and older. 143,146,147 Single-dose safety and tolerability of 7% HTS and 3% HTS in infants and toddlers with CF have been reported, 148,149 and recently, the short-term tolerability, adherence, and safety of 7% HTS in infants and toddlers with CF aged 12 to 30 months in a three-center open label 14-day trial have been confirmed. 150 The treatment group received nebulized 7% HTS twice daily for 48 weeks and the control group received 0.9% isotonic saline (ITS).…”