Friday, 21. September 2012

Salt and… Physiotherapy!

High volumes of 5.8% hypertonic saline (HS) and physiotherapy are well tolerated in the treatment of cystic fibrosis (CF)

Several studies highlighted the effects of hypertonic saline (3-12%) to be an effective, well-tolerated and cost-efficient approach1,2,3 in the treatment of respiratory diseases.

Hypertonic saline reduces the number of pulmonary exacerbations, improvement of lung function and increase of mucociliary clearance in the treatment of cystic fibrosis4,5,6,7,8.

Above all hypertonic saline is an established treatment for basic airway clearance in CF worldwide. In the latest Cochrane Review general concentrations of 5-7% in 4ml are recommended9,10.

At this year`s ECFC congress the practical application and tolerance of high volumes of hypertonic saline together with standardized chest physiotherapy in the daily routine of a CF-patient was presented11.

8 CF patients (mean age 15.3 yrs) first inhaled salbutamol twice daily. Thereafter first 3.35% initial and then 5.8% HS was given integrated with standardized physiotherapeutic breathing exercises.

The volume inhaled ranged from 4.5 ml-9 ml and was given age dependent for 89.3 (SD 7.7) weeks.

All patients tolerated both HS-concentrations well.

 Diagramm - Hammer 2012

Fig: Mucus production increased from 15.3 ml to 76.4 ml after inhalation with 5.8% HS11 for 89.3 weeks; 5.85%≙1 mole solution


The inhalation of 5.8% hypertonic saline showed the following effects:

  • Highly increased mucus volume
  • Improved lung function.
  • Increased satisfaction with daily treatment from 6.7 to 8.3 VAS (VAS: visual analogue scale 1-10)

This study shows the good clinical efficacy of 5.8% HS. Even high volumes with standardized breathing exercises were well tolerated in the CF therapy.

1 Elkins et al; Curr Opin Pulm Med. 2006 Nov;12(6):445-52
2 Dellon et al; Pediatr Pulmonol. 2008 Nov;43(11):1100-6
3Elkins et al; N Engl J Med. 2006 Jan 19;354(3):229-
4Eng PA et al.; Pediatr Pulmonol. 1996;21(2):77
5 Donaldson SH et al.; N Engl J Med.2006; 354(3):241
6 Elkins MR et al.; N Engl J Med. 2006;354(3):229
7 Elkins MR et al.; Pediatric Pulmonology.2006 (supplement 28):292
8 Ballmann M & von der Hardt H; Journal of Cystic Fibrosis. 2002; 1(1):35
9Dentice et al; J Physiother. 2012;58(1):33-40
10Wark et al; Cochrane Database Syst Rev. 2009 Apr 15;(2):CD001506
11 Hammer et al; ECFC 2012; abstract 186