Hypertonic saline is an inhaled sterile salt solution, which has a higher concentration of salt than blood plasma and may be effective in non-CF bronchiectasis airway clearance.
This solution enhances airway clearance because it increases the flow of liquid into the airway surface, due to the differences in concentration in salt in the solution and in the plasma (the usual plasma concentration is 0.9% and hypertonic saline concentration varies from 3-7%).
How does hypertonic saline solution for bronchiectasis work?
The mechanism of action of hypertonic saline solution for airway clearance in people with bronchiectasis is not well-known, but it is thought that it improves airway clearance by increasing hydration of the airway surface layer and mucus, making it easier to cough.
Studies of hypertonic saline solution in bronchiectasis
A preliminary study suggested that hypertonic saline may be effective in non-CF bronchiectasis. Twenty-four participants with stable bronchiectasis were divided into four groups, randomly receiving one of four different single-session treatments: Active cycle of breathing technique (ACBT) alone; nebulized terbutaline followed by ACBT; nebulized terbutaline followed by isotonic saline (0,9%); and ACBT and nebulized terbutaline followed by hypertonic saline (7%) and then ACBT. Isotonic and hypertonic saline improved sputum quantity, reduced sputum viscosity and improved ease of cough, with a benefit for hypertonic saline.
A Phase 3 study (NCT00484263) determined if daily inhalation of nebulized hypertonic saline (6%) decreased the incidence of pulmonary exacerbations and increased the quality of life of people with non-CF bronchiectasis. The primary objective of the study was the number of pulmonary exacerbations, or flares, during one year, and the secondary objective was improving the quality of life as measured by the St. Georges Respiratory Questionnaire (SGRQ). Forty people were included, with half inhaling isotonic saline (0,9%) and the other half inhaling hypertonic saline solution (6%). Both groups had a similar number of flares, similar lung function and improved quality of life. There was a reduction in sputum colonization in both groups. “This study demonstrates that the long term inhalation of a saline solution in people with non-CF bronchiectasis is a safe and possibly clinically beneficial treatment,” concluded the report, which was published in the Respiratory Medicine Journal.
Recommendations for hypertonic saline use in bronchiectasis
Although studies fail to show a consistently significant benefit for hypersaline solution, it does exist in some, and either isotonic or hypertonic solution seem to be beneficial in non-CF bronchiectasis.
When nebulized hypertonic saline solution is administered for the first time, it is recommended that a spirometry test be administered and that oxygen saturation be determined. People with bronchial hyper-reactivity should pretreat with a bronchodilator before nebulizing hypertonic saline solution.
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