Hypertonic Saline in the treatment of Asthma

[abc509]

I am a 27 y.o. female with a lifelong history of severe, persitant, at times uncontrolled asthma. Yesterday I participated in a research investigation looking at inflammation of airways that required sputum induction to examine the inflammation. I used varying amounts of hypertonic saline (3%, 4%, 5% for seven minutes each) which was preceeded by an albuterol treatment to prevent bronchoconstriction. Yesterday afternoon I had never felt better in my entire life (literally). I breathed with new freedom and I felt significant relief in terms of nasal allergy. I am wondering if hypertonic saline has ever been used to treat asthma in conjunction with other medications.

As a researcher myself (though not in medicine) I attempted to look in medical journals for its use but saw nothing. While I intend to talk to my personal dr in more detail about this I do not have an appointment for a few weeks. The dose that gave me the most movement of sputum was the 5% but I did not produce a lot at any level (though the doctor commented that I definitely sounded like I had a fair amount that should have come up and at a higher dose I probably would have seen a large amount produced but the protocol only called for 5%). I currently am maxed out (or so I'm told) on asthma and allergy medicine.

I take Advair 500/50 2x/daily, Singulair 10 mg, Albuterol 2-4x daily nebulized, and 110mcg Flovent 2x/daily (to avoid using oral steroids), 20 mg Zyrtec, Rhinocort 2squirts/2x daily, Patanol 2drops/2x daily. I felt no relief of eye or skin allergy problems.  I have had tons of testing to make sure this isn't anything else but everything comes back negative. I have a high IgE (but am hoping to avoid Xolair).

Your thoughts or comments would be appreciated and/or references to Hypertonic Saline in the treatment of Asthma in journals would be equally appreciated.

[cklhelb]

A related discussion, Comment was started.

[abc509]

I'm not sure you'll respond to this but I'm going to give it a shot. Clinically, pulmonary function stayed exactly the same. At the time of assessment asthma was very stable. I had not had an exacerbation for at least one week. I even test in a somewhat normal range pre and post. I can't really explain what I felt or what I sounded like clearly but I guess I'd explain it as sounding rattle-y (not a wheeze per se). My oxygen saturation did drop a few percentage points pre and post (though was not assessed during inhaling the hypertonic saline). Post was several minutes after the end of inhaling (as I expected that I would clear sputum based on how I sounded and what I felt maybe technique is bad, researcher suggested since I am not used to regularly producing) and o2 sat went from 97% to 94%. I was pre-treated (so I'm not sure of the impact of that).

Though I suppose it is possible, I do not have typical symptoms of cf and I am seen at the pulmo/cf clinic at my hospital (major teaching university w/ a well respected cf program) so I imagine they might recognize cf. I have not been tested either. However, I 'remarkably normal' in terms of weight and to even some extent baseline pft scores (if I'm not having an exacerbation   I am generally in the 70% range for fev1).  I have been tested for everything else including complement disorder, immunodeficiency problems, alpha-1 when I switched from my previous dr to them in order to find answers to unremitting resp., sinus infections and asthma exacerbations. If you have additional thoughts they would be appreciated.

[National Jewish Health]

Your response is remarkable, especially since your improvement was not accompanied by the clearing of large amounts of sputum.  It is also surprising, given that 4.5% hypertonic saline is conventionally used to assess bronchial hyperreactivity, similar to the use of methacholine.  Thus, one would have expected worsened breathing.  It would be of interest to have pulmonary function tests (PFTs) data, to see if your clinical improvement was accompanied by objective measures of airflow.

Therapeutic hypertonic saline has been used with much success in people with cystic fibrosis (CF).  Short and longer term studies have shown that inhalation of hypertonic saline is well tolerated and improves lung function, reduces exacerbations and improves quality of life in people with CF.  Is it possible that your "asthma" is an expression of CF?

On a practical note, you might want to ask the researchers to have you back for another session of hypertonic saline inhalation, to see if the effect you experienced is reproducible and, if so, might be considered as an ongoing part of your asthma therapy.  Given that this saline ordinarily results in bronchoconstriction, any such trial would have to be done with the approval of your primary care physician and with very close monitoring.