How did nebulizing with saline affect you?

I am also doing AC 7 % saline now as my pulmonologist and pharmacist is insisting that I do it and take data daily on how I"m doing.She will have me turn in the data to her at some point. When I receive the diagnosis of BE and NTM MAC and on big 3 for 14 months in 2019-2020, I had no productive cough phlegm. A couple years later I developed productive cough once my pulmonolgist prescribed the nebulizing AC. I have been consistently doing AC nebulizing now since Aug 1st,2025 and will continue to do so and take data. So far I do seem to be feeling some better, but its a huge time crunch for me and I lose sleep to get it all in and I have a very very demanding job. It seems to make the mucus thinner, but the time delay is there. I can't control when I cough it up. It comes up whenever it wants to. I had 2-3 lung infections earlier this year in Jan- March, and I want to prevent future ones. Pulmonologist says I am not a candidate for Brensocatib even though I have high neutrophil inflammatory count from April 2025 bronchoscopy.

@pacathy You might be onto something with regard to airway clearance and CF. The scant evidence for airway clearance is not surprising. After all, there's no pharmaceutical involved! Nonetheless I feel much better (albeit temporarily) after airway clearance and I feel like I am doing something to prevent the phlegm from pooling and tempting some pathogen to take up residence in my lungs. In addition AC cuts down on the amount of coughing I do in-between clearance sessions.

Here are 2 articles I found convincing.

@pacathy You might be onto something with regard to airway clearance and CF. The scant evidence for airway clearance is not surprising. After all, there's no pharmaceutical involved! Nonetheless I feel much better (albeit temporarily) after airway clearance and I feel like I am doing something to prevent the phlegm from pooling and tempting some pathogen to take up residence in my lungs. In addition AC cuts down on the amount of coughing I do in-between clearance sessions.

Here are 2 articles I found convincing.

Here is a link to the published article, complete with tables, that I found easier to read:
https://publications.ersnet.org/content/erj/62/1/2202053
This is the European Respiratory Society conclusion after reviewing thousands of studies:
"The current evidence supports that ACTs are an effective treatment and have a crucial part in the usual care of adults with bronchiectasis. Accessibility to ACTs should be facilitated and ideally delivered by a specialist respiratory physiotherapist. However, there is limited evidence establishing the physiological effect of these techniques and current clinical practice based on geographical regions remains largely unclear. The use of data from large patient registries could help to better understand ACT practice globally. Randomised clinical trials indicate that ACTs increase the expectorated sputum, improve disease symptoms and HRQoL and reduce the risk of exacerbations, although they often have an unclear risk of bias or a poor description of their techniques. There is a great need for studies to investigate the role of ACTs during acute exacerbations of bronchiectasis and in the long term. Additionally, researchers can consider different settings, new modes of application and novel outcomes for future ACTs studies. Importantly, to achieve optimal care, study designs need to incorporate patient-centred outcomes and patient voice."

I will offer my own "study" - In the three plus years since I have been 1) managing my asthma properly and 2) doing daily airway clearance (using 7% saline for some sessions) I have gone from 2-3 exacerbations per year requiring steroids and antibiotics to 2 exacerbations in 39 months. During that time I have traveled extensively, been around lots of kids and older people (both groups are great at spreading their germs), and had a bout of Covid.

Scientific studies or not, I am convinced.

BUT what did interest me is that NOT ONE of the cited studies in the tables recommended trying to get rid of "every last bit" of mucus. So I stand by the advice of my very first pulmonary nurse - never more than 20 minutes per session (after the neb).

While there is limited data on hypertonic saline in MAC, there's a long history of its use in cystic fibrosis and many/most of those patients develop bronchiectasis. There's a study by Elkins in the prestigious NEJM from 2006 studying the long term effects of hypertonic saline in CF patients that showed decreased exacerbations, etc. and determined it was safe. I think that long background is one of the reasons the pulmonologists we see feel comfortable in recommending it. There are other studies in that population as well. While it's not MAC, there's are certainly similarities with the goal being getting mucus cleared. My pulmonologist also sees adult cystic fibrosis patients.

I too have found completing airway clearance to be quite time consuming. However, I attribute regular - once daily - nebulizing with 7% saline solution in addition to other techniques - to my most recent sputum samples being negative for MAC. I was positive for MAC about a year and a half ago, but we opted for the watch and wait plan.

I too have found completing airway clearance to be quite time consuming. However, I attribute regular - once daily - nebulizing with 7% saline solution in addition to other techniques - to my most recent sputum samples being negative for MAC. I was positive for MAC about a year and a half ago, but we opted for the watch and wait plan.