Really always 6% NaCl in children?

Question

Hello,
we have a 6-year-old daughter (CF) with a very mild pulmonary course. For about 3 years she inhales 3% NaCl (and 4 drops salbutamol), before this 0,9% NaCl. The center now recommends that our daughter inhales in the future with 6% NaCl (plus 5 drops of salbutamol). Is this reallly necessary? Or does it not make sense to moisture the airways with 3% NaCl, especially as our daughter has few secretions and to use 6% NaCl in times of infection? Recently our daughter has inhaled because of an infection only with 6% NaCl, she coughs with this very, very strong and she says often, that she has an urge to gag. Is this intended? I have contact to some adult CF patients and I know, that they often do only inhale with 0,9% or max. with 3% NaCl. I am very happy about your appreciated opinion.
Many thanks.

Answer

Hello,
you ask, if your 6-year-old daughter now has always to inhale with 6% NaCl, after she has inhaled until now routinley only with 3% NaCl and the 6% NaCl has only been used in case of infections. At last the physicians of your CF center recommended a continous inhalation with 6% NaCl.
You report however, that your daughter has partly strong cough when inhaling 6% NaCl and even has an urge to gag.
The usage of high percentage NaCl solution should be done in general according to the individual health status of the single patient and according to tolerability. If under the usage of 3% NaCl the bronchial secretions can be coughed up well and the lung presents at auscultation free of mucus, this concentration is sufficient. In case a "congestion of secretions" should occur during ausculatation, a higher concentration of NaCl soultion should be tried. Some patients inhale even with 7% NaCl. In case of usage of the higer concentrations it is very important, to pay attention to the fact if the patient tolerates it well. It is known, that some patients react with narrowing of the bronchi (bronchospasm) and an urge to cough, that is not relieved by the usage of salbutamol. In this situation the high concentration should not be used. A usage of exclusively 6% NaCl without any alternative is not common. As already mentioned above, the concentration should be adjusted individually. Therefore you should discuss with your CF physicians in charge the observed "side effects" (strong urge to cough, urge to gag). For sure a soultion can be found.

We wish you and your daughter all the best,
Best regards,
Dr. H.-G. Posselt

07.02.2015