Earlier today I said I would look around for an easier-to-understand explanation of how high the saline dose needed to be to be lethal to mycobacteria. Wow, my eyes are crossed from reading through abstracts, and I still don't have any easy answer, people. Here is the best I can offer: an article linked to NIH in 2016: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850692/pdf/13104_2016_Article_2054.pdf It is published by BioMedCentral, and is a recap of the results of numerous studies, kind of heavy reading. However, if you look at page 5 there is a chart, covering many strains of mycobacteria we discuss here.
What I was able to glean from all of it: Mycobacteria strains are susceptible to destruction by salt of various concentrations in lab tests.
Here are some common ones:
TB and Bovine TB 4%
M avium & intracellulare 6%
M chimaera 5%
M abcessus 8%
While nothing in the article states conclusively that nebulized saline in those concentrations will actually eradicate NTM in the lungs, I believe this led to the recommendations (and some European studies) where hypertonic saline nebs are used to thwart MAC. I believe that we will see more results coming in the future. In addition, the nebulized saline serves to thin the mucus and make it easier to expel by coughing.
Here is my personal takeaway - compared to the Big3 antibiotics, and even less desirable additional meds like IV or inhaled Amikacin, 7% hypertonic saline is fairly benign and inexpensive. If it even stunts the growth of any MAC remaining in my lungs after long-term antibiotics, it is worthwhile for me. Even better if it actually kills the bugs or prevents reinfection from the environment!
Next I am going to explore whether a hyper-saline soak will kill NTM on our nebulizer parts, flutter devices, etc. It's a lot more readily available to me than industrial strength vinegar.
Sue

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