Addition of hyaluronic acid improves tolerance to 7% hypertonic saline solution in bronchiectasis patients

Abstract

Background:The excessive retention of sputum in the airways, leading to pulmonary infections, is a common consequence of bronchiectasis. Although inhalation of 7% hypertonic saline (HS) has proven an effective method to help remove the mucus, many patients are intolerant of this treatment. The addition of 0.1% hyaluronic acid to HS (HS+HA) could increase tolerance to HS in these patients. The main objective of this study was to evaluate the tolerability of HS+HA in bronchiectasis patients who are intolerant to HS.Methods:This prospective, observational, open-label study analysed the outcomes of two groups of bronchiectasis patients previously scheduled to start HS therapy. Patients were assessed for tolerance to HS by a questionnaire, spirometry and clinical evaluation. Patients who were intolerant were evaluated for tolerance to HS+HA approximately one week later. All patients were evaluated for their tolerance to HS or HS+HA 4 weeks after the start of their treatment. Patients were also assessed with quality-of-life and adherence questionnaires, and all adverse events were registered.Results:A total of 137 bronchiectasis patients were enrolled in the study (age = 63.0 ± 14.7 years; 63.5% women). Of these, 92 patients (67.1%) were tolerant and 45 patients (32.9%) were intolerant to HS. Of the 45 patients intolerant to HS, 31 patients (68.9%) were tolerant and 14 patients (31.1%) intolerant to HS+HA. Of these 31 tolerant patients, 26 (83.9%) could complete the 4-week treatment with HS+HA.Conclusions:Two-thirds of bronchiectasis patients that presented intolerance to inhaled HS alone are tolerant to inhaled HS+HA, suggesting that HA improves tolerance to HS therapy.

Use of Hyaluronic Acid (HA) in Chronic Airway Diseases

“…The three randomised clinical trials published have remarkable differences in the design, inclusion and exclusion criteria; HS dosing and nebulisers used, which makes it difficult to establish an indirect comparison among them [ 73 ]. Adverse events found with HS were very similar to those found in CF patients [ 62 , 63 , 64 ], even when the percentage of patients that did not tolerate the treatment was higher [ 14 ].…”

“…Due to this capability to mitigate HS adverse events, some treatment guidelines recommend the administration of HA + HS in patients intolerant to HS [ 66 ]. In this regard, two clinical trials with clearly different designs evaluating the tolerability of HS + HA in patients with bronchiectasis [ 14 , 76 ] have been recently published, supporting the recommendations included in some guidelines ( Table 3 ).…”

“…The HS + HA inhalation resulted in less significant adverse events leading a withdrawal of the study than HS alone. The authors concluded that HS + HA improved the tolerance to HS [ 14 ].…”

“…Furthermore, high-molecular weight HA administered via aerosol or tracheal instillation may act against anti-inflammatory agents, protect against hyperreactivity, delay the appearance of bronchial remodelling and modify the biofilm related with the chronic inflammation caused by certain potentially pathogenic microorganisms. Thus, the treatment with HA in its different formulations might play a key role in airway diseases with a high inflammatory component, such as chronic rhinosinusitis, asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF) and the bronchiectasis from other etiological causes [ 10 , 11 , 12 , 13 , 14 ]. HA is also used as a mucolytic during bronchoscopy to extract the mucus that obstructs the airways [ 15 ].…”

Hipertoniczne roztwory soli w terapii chorób dróg oddechowych

“…Kolejnym wskazaniem do stosowania HRS są rozstrzenia oskrzeli niezwiązane z mukowiscydozą. W tych schorzeniach wykazano, że inhalacje z HRS lub IRS mają podobne efekty, biorąc pod uwagę wpływ na zaostrzenia choroby, jakość życia chorych, kolonizację plwociny i parametry spirometryczne w okresie co najmniej 12-miesięcznej terapii [36] U osób nietolerujących HRS dodanie kwasu hialuronowego może tę tolerancję poprawić [39].…”