Hypertonic Saline May Boost Benefits of Airway Clearance Techniques in Children

Hypertonic Saline May Boost Benefits of Airway Clearance Techniques in Children

Airway clearance techniques (ACTs) incorporating the use of hypertonic saline solutions — solutions with a higher salt concentration than blood plasma — for nebulization can improve lung function and lower flare-ups in children with non-cystic fibrosis bronchiectasis, a small clinical trial has found.

These results suggest that using such solutions “is an effective strategy” for treating children with this progressive disease, the researchers said.

Trial findings were reported in the study, “Effectiveness of Hypertonic Saline Nebulization in Airway Clearance in Children with Non‐Cystic Fibrosis Bronchiectasis: A randomized control trial,” published in the journal Pediatric Pulmonology.

Bronchiectasis is a lung disease in which the bronchi, or small lung airways, become inflamed due to chronic infections. Over time, these small airways become irreversibly thicker and larger. People with bronchiectasis also tend to produce large amounts of mucus they are often unable to expel. This sticky mucus can trap harmful bacteria in the lungs’ airways and make patients more likely to develop lung infections.

The most effective way to break this cycle is to combine the use of therapies that tackle the root of the problem with supportive treatments that help patients expel mucus and keep their airways clear. ACTs, which involve coughing, huffing, and sometimes vibration to help loosen mucus from the airways, are a key supportive treatment for bronchiectasis.

Based on observations in people with cystic fibrosis (CF) — a rare genetic lung disorder that results in thick mucus building up in various organs, including the lungs — most international guidelines for bronchiectasis also recommend that nebulization with hypertonic saline solutions be given to patients prior to ACTs. This is because these high-salt solutions are known to disrupt mucus’ structure, lowering the thickness of its consistency (viscosity), and facilitating its expulsion.

Yet, it is still unclear if the use of hypertonic saline solutions before ACT might be truly beneficial for children with non-CF bronchiectasis.

To answer this question, researchers in Sri Lanka conducted a crossover clinical trial enrolling children with this disorder, ages 5–15.

In the first phase of the study, the children were randomly assigned to receive inhaled salbutamol, also known as albuterol, followed by nebulizations with a hypertonic saline solution containing 3% of sodium chloride, or salbutamol alone, before standard ACT (chest physiotherapy). Treatment was given twice daily for nearly two months.

This initial phase was followed by a washout period for a month, in which the patients’ bodies could eliminate any carry-over effects of the medications. After that, they switched treatment groups and were monitored for an additional period of two months.

Data on patients’ lung function and the number of flare-ups (disease exacerbations) they experienced were collected at the end of both study phases and the washout period.

A total of 52 of the 63 children enrolled were able to complete the study; together, 21 boys and 31 girls. Reasons for not completing the study included difficulties with traveling to the clinic and an unexpected shortage of 3% saline in the country.

Demographic characteristics, including sex ratio, mean age, and mean age at the time of diagnosis were identical in children from both groups.

Analyses at each stage of the trial showed that children who received hypertonic saline nebulizations had better lung function than those who received salbutamol alone before having ACT. This was reflected by significantly greater improvements in two lung function parameters: forced expiratory volume in one second (FEV1) and forced vital capacity (FVC).FEV1 measures the total amount of air exhaled in one second after a deep breath, while FVC measures the total amount of air a patient is able to exhale after a deep breath.Additional analyses also demonstrated that children who received hypertonic saline nebulizations tended to experience a lower number of exacerbations compared with those treated with salbutamol alone before ACT. This was true in the first (mean of 0.42 vs. 1.30 flare-ups per child) and the second phase of the trial, in which the mean flare-ups per child were 0.65 vs. 1.03.However, these differences were only statistically significant in the first portion of the trial.

“Incorporating HS [hypertonic saline] nebulization into ACT is an effective strategy to improve dynamic lung volumes and morbidity in children with non‐CF bronchiectasis,” the investigators wrote.
“Therefore we recommend the use of this technique in the management of non-CF bronchiectasis and to further study this with a larger sample as well as to replicate on CF patients as well,” they added.