Is a saline grotto beneficial for a CF child?

Question

Dear experts,

A saline grotto opened close to where we live [a link with further German information was given]. Our CF child (6) has problems with the upper airways, the nose is never completely clear despite inhalation with Pari Sinus and nasal wash (nasal polyps are not that big; an operation is not planned). So far, we have been to the grotto once and it was a very positive experience for our child; the nose was almost clear. Is visiting a saline grotto recommended in addition to the therapy and if yes, how often should a CF individual visit it to have a therapeutical effect?

Answer

Hello,

Although the level of suffering seems to be high in your case it is though pretty time consuming to visit a saline grotto. Treatment by staying in a grotto is called “speleotherapy” – but there is almost no scientific data about it; I did not find anything about CF regarding this topic. A factor for this can be that pseudomonads could be found in stale water of a grotto and water could also drop from the ceiling of a grotto.

The nasal wash (“nasal douche”) which is used by your child is especially effective for removing secretion and crusts. Regarding the inhalation with the Sinus it would be interesting to know what has been nebulised and if your child, being 6 years old, is already able to use the nebuliser effectively. This would include to do the following things simultaneously: close the velum (soft palate), partial closure of the other nostril and holding the breath during inhalation intervals are necessary. In scintigraphic tests it has been proven that medicaments can be inhaled into the sinus this way. By way of control for the user: effective inhalation will result in a vibration above the nasal root or the sinuses. If your child is able to use the nasal douche correctly it can also specifically close the velum, which would be a pre-requisite for effective inhalation into the sinuses. We have seen that patients from the age of eight are more likely to inhale effectively after training with the Sinus (nebuliser).

Pulmozyme® (Dornase Alpha) or the inexpensive hypertonic saline that we use in our studies with the Sinus are effective for the superficial solution and liquidation of the secretion. However, according to your description, the problem is especially the congested respiration via the nose. In this case it does make sense at all events to try a therapy with topical steroids. The dosage of those modern cortisones is so low that no relevant blood level and the feared side effects do not occur. Recommended are, e.g., Nasonex®, Avamys® and the predecessor Flutide Nasal® (Fluticasone furoate) or Budesonid nose spray. The older Beclomethason takes more effects on the blood and should therefore not be used for children.

1-2 times a day 1-2 puffs/sprays are applied into each nostril. The mentioned sprays are partially not approved for small children because the companies did not want to spend the license costs for this age groups. Although bigger therapy efforts are said to happen with regards to allergic nose problems we do see a tendence for CF that in most cases there is an improvement after a couple of weeks. If the ear, nose and throat specialist did not see any findings that make an operation obligatory I would also expect this to happen in your child. In some cases even findings that make an operation obligatory did improve that much that the operation could be postponed.

Best regards,
Dr. J. Mainz

14.04.2010