Background Nebulised hypertonic saline (HTS) improved lung function, quality of life and exacerbation frequency in a study of patients with non-cystic fibrosis (CF) bronchiectasis1. It may improve chest clearance by increasing water content of airway surface liquid, enhancing mucociliary clearance. A protocol was developed for the use of HTS in a district hospital setting. Safety, tolerability, lung function and quality of life data are presented.
Methods Patients with non-CF bronchiectasis were assessed on a locally developed chest clearance pathway consisting of active cycle breathing technique, postural drainage, flutter device and mucolytic. Patients with ongoing symptoms were given a trial dose of 4 mls HTS 7% with spirometry measured pre and post. Patients continued on 4 mls HTS od/bd for 12 months if tolerated. Adverse effects, quality of life and spirometry was collected at 4 weeks and 6 months. Data were compared using paired t tests.
Results 34 patients (mean age 62, 25 female, mean FEV1 66% predicted) were assessed. 2 (6%) patients did not proceed with treatment due to (a. FEV1 decline >15% and b. severe nausea). 9 (26%) patients experienced mild side effects. FEV1 improved significantly at 4 weeks (1.53 vs 1.41 p = 0.01). Leicester Cough Questionnaire improved significantly at 4 weeks (mean total score 13.7 vs 11.8 p = 0.0003) with a mean difference in LCQ of 1.9 (minimum clinically important difference MCID > 1.32). St Georges Respiratory Questionnaire improved significantly at 6 months (mean total score 56.1 vs 67.8 p = 0.01) with a mean difference of 11% (MCID > 4%3).
Conclusions In this uncontrolled study, HTS was well tolerated and resulted in improved lung function and quality of life in patients with non-CF bronchiectasis.
Kellett F Niven RM. Nebulised 7% hypertonic saline improves lung function and quality of life in bronchiectasis. Respiratory Medicine 2011; 105: 1831–1835.
Raj AA et al. Clinical cough IV: what is the minimally important difference for the Leicester Cough Questionnaire? Handb Exp Pharmacol 2009; 187: 311–320.
Jones PW. Interpreting thresholds for a clinically significant change in health status in asthma and COPD. Eur Respir J. 2002; 19: 398–404.
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