Background Non-Cystic Fibrosis (CF) bronchiectasis is an understudied clinical area. Many studies are extrapolated from CF despite prior evidence suggesting this is not wholly appropriate. Recent BTS guidelines have suggested a role for Hypertonic Saline (HS) after findings from Kellet et al (2008). In that study, a nebulised (7%) HS challenge test was done and subjects were to be excluded from ongoing HS therapy if they reported ‘chest tightness’, ‘wheeze’ or ‘difficulty in breathing’, or had a 10% reduction in spirometry following inhalation of HS. Notably none of 23 patients were excluded on these criterion. We hypothesised that a fall in FEV1 greater than 10% would be more common in a non study population but of limited clinical significance.
Methods We reviewed our 6% hypertonic saline challenge (baseline, post 2.5 mg Salbutamol and post 6% HS) data from consecutive patients commenced on this therapy due to mucus retention despite other interventions (eg, physiotherapy and/or mucolytic) Results: 33 patients were identified (20F, 13M) mean age 61.5±13 years, mean baseline FEV1 was 1.37L±0.7 (range 0.4–2.65) mean FEV1% predicted 54%±25% (range 23–111%). One patient's data were excluded due to inability to reproducibly perform spirometry. The mean change in FEV1 from baseline was +4.3%±10.8 % (range −21 to −36) and fall from post Salbutamol was −0.64±11.6% (range −14 to +14%). Seven patients have stopped HS therapy either due to chest tightness or taste (20%).
Conclusions This cohort is larger than that previously reported and includes a wider range of airflow obstruction severity. No exclusion criterion were applied to trying HS. The overall fall during an acute HS challenge in an unselected bronchiectasis population is small. Despite this many patients discontinue HS within 3 months of initiation.