Background Nebulised hypertonic 7% saline enhances sputum clearance in patients with bronchiectasis and hypersecretion (Kellet F et al Med 2005; 99:27–31) but is not licensed for this purpose. It is expensive to produce, has a short shelf life and is difficult to administer. Mucoclear® 6% saline does not have these disadvantages so we wished to evaluate its clinical benefits.
Method Patients with troublesome bronchiectasis were invited for a nebulised 6% HTS challenge. If no adverse reaction occurred, they administered HTS daily for 2 months
Results 60 patients were assessed over 18 months. Ten had bronchospasm after HTS, 9 did not wish to continue treatment and 41 reported an initial positive response and administered HTS once daily for 2 months. All 41 patients reported improved ease of sputum clearance with a median 3 point increase on a 10 unit Viausal Analogue Scale. 49% reported increase in sputum volume. 10 patients had baseline oxygen saturation ≤95% with ≥2% rise on HTS. 59% reported an increase in quality of life on Juniper mini asthma quality of life questionnaire (mean 0.6 unit rise overall and 1.0 for responders; rise of >0.5 units is significant). Mean FEV1 rose 9.5% (from 1.68 to 1.84 litres) and mean FVC rose 10.5% (from 2.48 to 2.74 litres). (Wilcoxon test p<0.001). There was no change in spirometry for seven patients with normal baseline measurements but FEV1 rose by 13% and FVC rose by 12% among 34 patients with abnormal lung function. All patients reported a noticeable improvement in their condition (12% reported “life changing improvement”).
Conclusion Despite standard therapies some adults with bronchiectasis have persistent troublesome hypersecretion. Two thirds of our patients reported a significant improvement in symptoms using HTS and, for some, this was life changing. This suggests that Mucoclear® 6% hypertonic nebulised saline is a viable option but controlled trials are needed.