Effectiveness of hypertonic saline nebulization in airway clearance in children with non‐cystic fibrosis bronchiectasis: A randomized control trial

Abstract

Introduction: Failure to expectorate mucus resulting in progressive airway damage is the hallmark of bronchiectasis. Therefore effective airway clearance techniques (ACT) is the key step in its management. The aim of this study was to evaluate the efficacy of 3% hypertonic saline (HS) pre-medication in ACT in children with non cystic fibrosis (non-CF) bronchiectasis. Methods: In this randomized crossover control trial five to 15 year old children, diagnosed with non-CF bronchiectasis were randomized either to receive 200 µg of inhaled salbutamol followed by HS nebulization (test) or only 200 µg of inhaled salbutamol, before chest physiotherapy which is the conventional ACT (controls) for 8 weeks. Inhaled salbutamol was administered via a pressurized metered dosed inhaler with a valved holding chamber. After completion of first phase both groups went through one month washout period, before being crossed over to the opposite arms in the second phase. Spirometric parameters and number of exacerbations were recorded at the end of phase I, washout period and phase II. Results: Fifty two out of 63 enrolled completed the study. Baseline characteristics of the two groups were similar. A significantly higher mean improvement was seen in predicted forced expiratory volume in 1 s in the HS arm during phase 1 (HS =

The modulatory effect of high salt on immune cells and related diseases

“…Hypertonic saline inhalation in patients with cystic fibrosis can rehydrate the airway surface liquid, increase mucociliary clearance and improve lung function 229,230 . Most guidelines recommend the use of nebulized hypertonic saline in bronchiectasis therapy to facilitate airway clearance 227,231 . Nonetheless, studies about the application of nebulized hypertonic saline in patients with viral bronchiolitis demonstrated conflicting results 228 .…”

Bronchodilator response to albuterol nebulized with hypertonic saline in asthmatic children

“…25 HSS osmotic effects on the airway surface layer increase the volume of the periciliary layer phase and consequently improves mucociliary clearance. HSS diminishes mucus viscosity in CF, [26][27][28] non-CF bronchiectasis, 29 bronchiolitis, chronic bronchitis, 30 ciliary dyskinesia, 31 and other diseases with chronic mucus overproduction, determining less retention of secretions and lower incidence of opportunistic infections. HSS has also been extensively evaluated in acute bronchiolitis.…”

Current and Future Treatments in Primary Ciliary Dyskinesia

“…In CF, nebulized hypertonic saline (HS) reduces the frequency of pulmonary exacerbations in children >12 years and adults, and slightly improves the quality of life of adult patients [45]. In non-CF bronchiectasis, the evidence is contradictory, but a well-designed 52-week trial on the effect of HS on exacerbation frequency in adults is underway [42,[46][47][48]. A carefully designed double-blind, randomized, placebo-controlled cross-over study in PCD evaluated the effect of inhaled HS compared to inhaled isotonic saline (IS) on quality of life in 20 adult PCD patients [22].…”