Hypertonic saline

Vraag

Can you explain me what the advantages and/or disadvantages are of the inhaled hypertonic saline in cystic fibrosis patients. Some patients show good results, other far less. Could you explain me what the basis is of this different response ? Thanks.

Antwoord

Dear sir, madam
In cystic fibrosis (CF) , the normal clearance of mucus by the ciliated cells of the respiratory epithelium fail. Based on lab work, the hypothesis has been forwarded that this mucus clearance failure is the result of dehydrated airway surface and collaps of the cilia. In the lab, hypertonic saline (HS) corrects this deficit.
Inhalation of HS induces cough and leads to expectoration of sputum. Several studies in CF patients have demonstrated that a single inhalation of HS improves mucus clearance from the lung in a dose dependent fashion during at least 8 hours (measured after inhalation of radio-active labelled particles). In short term studies (2-3 weeks) HS treatment results in an improved lung function although with variable patient responses which cannot be predicted based on patients characteristics like age, lung function, Pseudomonas status.
After long term (48 weeks) treatment, HS did not clearly improve lung function, although again there were large inter individual patient differences. In the same study, the number of lung infections, antibiotic use and school/work absenteeism decreased under HS treatment. In children under 6 years, there are no HS study data except one safety study in small children.

Possible advantages of HS
1. obtaining a sputum sample
2. short term improvement of lung function (after 2-3 weeks treatment). The individual patient response cannot be predicted.
3. increased sputum clearance from the lung. Data on long term treatment are scarce. The main effect seems to be decrease of respiratory exacerbations rather then long function improvement.
Disadvantages
1. HS induces bronchospasms (cough and wheeze). This can be prevented for most patients by pretreating with salbutamol. About 8% of patients will not tolerated HS despite administration of salbutamol.
2. increase burden of therapy (usually prescribed as extra nebuliser treatment)
3. inactivation of other inhaled drugs may occur secondary to high salt concentration. Timing of HS best away from other inhaled medications

Best Regards

Marijke Proesmans

18.08.2008