Background Nebulised Hypertonic Saline (HTS) has been shown to increase water content of airway surface liquid, enhance mucociliary clearance, reduce exacerbation frequency and improve quality of life in Cystic Fibrosis (CF) and non-CF Bronchiectasis. Historically HTS was associated with bronchoconstriction, therefore formal first dose bronchoconstriction trials (BCT) were performed. Recent studies have shown better tolerance that improves over up to 10 doses (Elkins 2006). We have observed that a fall in FEV1 >15% following nebulised HTS rarely correlates with adverse signs or symptoms, questioning the need for a BCT. This study aimed to assess our use of HTS, its safety and tolerance without BCT, and its positive effects.

Methods A senior physiotherapist completed a proforma for all patients commencing HTS over 6 months. HTS was used for different respiratory conditions to aid mucociliary clearance. All patients were pre-dosed with a bronchodilator, and had a closely supervised 1st test dose, replacing formal BCT.

Results 54 patients aged 19–87 years (mean 54, median 61) commenced 7% HTS. 35 were inpatients and 19 outpatients. The primary diagnoses were: non-CF Bronchiectasis (20), post thoracic surgery (17), CF (13), Pneumonia (2), long term tracheostomy (1), and COPD with Laryngectomy (1). All patients experienced positive effects, listed in table 1. HTS prescription was individualised: BD regime (42), TDS (8), QDS (4). 13 patients (24%) experienced adverse effects – increased cough (13), slight chest tightness (3), a 5% decrease in oxygen saturations (1). All 13 patients and physiotherapists considered the adverse effects sufficiently mild to continue HTS and they subsequently reduced significantly after up to 5 doses. If no adverse effects were experienced during the test dose, no further adverse effects occurred with continued use.

Conclusion This observational study demonstrates that HTS has positive effects in a wide variety of respiratory conditions. We have replaced BCT with a supervised test dose as it was found to a be a safe and efficient evaluation. Over 6 months HTS was well tolerated, with only mild adverse effects, which reduced over subsequent doses. Importantly, there were no adverse effects in patients who had previously undergone an uneventful test dose.