Pneumologie 2016; 70 - A38
DOI: 10.1055/s-0036-1592263

Effects of hypertonic saline on sputum clearance in patients with bronchiectasis

V Alcaraz-Serrano 1, B Herrero-Cortina 2, J Vilaró-Casamiitjana 3, E Rosales-Mayor 4, A Torres-Marti 5, E Polverino 1
  • 1Servicio de Neumología, Instituto Clínico Respiratorio, Hospital Clínic de Barcelona – Fundación Clínic para la Investigación Biomédica
  • 2Universidad de San Jorge, Zaragoza
  • 3Facultad Ciencias de la Salud Blanquerna, Barcelona
  • 4Ciber de Enfermedades Respiratorias (CIBERES), Hospital Clínic de Barcelona.
  • 5Servicio de Neumología, Instituto Clínico Respiratorio, Hospital Clínic de Barcelona – Fundación Clínic para la Investigación Biomédica, Ciber de Enfermedades Respiratorias (CIBERES), Hospital Clínic de Barcelona.

Hypertonic saline (HS) has been largely approved in cystic fibrosis to increase airways clearance while little evidence is available in bronchiectasis (BE).

Aim:

To compare 3 inhaled solutions (7% HS; 0.1% Hialuronic Acid [HA] + 7% HS and 0.9% Isotonic Saline [IS]) in terms of: expectoration, cough severity, lung function and safety.

Methods:

Was conducted a double-blind, randomized, crossover trial in BE patients. Patients inhaled each solution during 4 consecutive days, followed by a physiotherapy session (apart from 3 rd day). A 7-day washout period was used between treatments. Safety was analyzed using an adverse events' score. In each treatment arm, lung function and cough severity (Leicester questionnaire, LCQ) were measured. For statistical analysis a mixed model was used (significant p < 0.05).

Results:

24 patients were included with a mean age of 62.6 (17.6[SD]). HS was the worst tolerated solution. HS and HA+HS induced greater expectoration during inhalation than IS ([HSvsIS] 9.9 g vs. 3.9 g (p < 0.001); [HA+HS vs. IS] 8.1 g vs. 3.9 g (p < 0.001). Sputum obtained during physiotherapy period (1, 2, 4 day) was similar (p ≥0.6) regardless of inhaled solution. However, this amount was always greater than the 3 rd day without physiotherapy. No differences were observed in 24h post-session sputum collection (p ≥0.05) for days 1, 2, and 4, while it was higher for day 3 (15.9 vs. 21.9, p < 0.001). There were no significant differences in LCQ or in lung function. Most patients (45%) selected HA+HS as the preferred inhaled solution (IS: 29.2%; HS: 25%).

Conclusions:

This is the first study demonstrating that HA+HS and HS are more effective on sputum clearance than IS, being HA+HS better tolerated than HS. The combination HA+HS and physiotherapy was even more effective in reducing daily expectoration.