How did nebulizing with saline affect you?

Fifteen years is a long time to deal with this.

Fortunately, I haven't had MAC. I've been doing airway clearance since I went to Mayo 3 years ago, twice daily before cultures came back negative. When doc called the negative results, I asked if I could do daily clearance since I rarely produce sputum. She agreed. My local Penn doc suggested I started 7% last fall to try to prevent a recurrence of the frequent respiratory infections I'd had the previous winter and I haven't had one since November, despite having been around my young grandchildren who still caught the bugs going around school. I'm hoping that the saline helped and it's not coincidence, but recognize that possibility.

Thanks for the reply. I gather you have BE, never have had MAC? When I was dx'd with both, I had no symptoms and didn't for several years. I rarely get sick, remained physically active, etc. My main symptom the past 4 or 5 years has been coughing after exercise, coughing when I lie on my back, coughing sometimes in bed at night, occasional extended bouts of coughing for no apparent reason. I have lived at 5,000 ft the past 6 years and PFTs have been normal or "low normal." (Of course, the criteria for "normal" change as one ages; the expectation decreases.) My doc says my CT scans and bronchoscopy and don't match my actual functioning and seeming good health. This is why I haven't undertaken any treatment until this summer. And it's why I hope to clear this infection, eventually quit the meds, and maintain negative cultures. Hence, my interest in finding out what the positive effects of nebulizing are for people who use it.

@winema you ask good questions. I have been looking into the data supporting AC clearance and it is indeed scant. Mostly, it seems to conclude it helps patients feel better. Like you, I am largely asymptomatic, though with advanced disease, so AC doesn’t improve anything for me in terms of symptoms. There is one study that showed an improvement in bacterial loads for those nebbing saline, and another specific to NTM which was inconclusive due to its small size, but interesting. If you search this site, you should readily find links to those studies. There is apparently one (maybe two?) AC clinical trials underway with hypertonic saline and NTM but the duration is only 3 months and with the slow growing nature of NTM is hard to appreciate how much a three month study will really tell us. This is definitely an area that needs more data. As everyone knows, the time commitment of AC is HUGE HUGE HUGE. Obviously, if it helps one feel better, it’s a no brainer to include it in the proverbial toolbox. But for some of us, it makes no difference symptomatically whether we do AC or not. If it is not helping me otherwise, (i.e. reducing NTM load, reducing other bacterial infections, reducing impacted mucus that I cannot feel but my CT says is there), that’s a time commitment I don’t want to make. To be clear, I am doing my AC now because my NTM specialist says to do so, but even they acknowledged there is little data supporting the recommendation. It’s strange to me that my NTM specialist recommends AC, with little data supporting, but doesn’t recommend most environmental efforts, like e.g. boiling drinking water, because they say there is insufficient evidence to do so. Where is the line in all of this? Still trying to figure that out ….

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.

@bayarea58~Thank you, thank you!! This is very helpful information, and I really appreciate it, as well as your perspective! It's truly a balancing act: treating MAC/BE but, if possible, not letting the treatment take over one's life. I am fortunate that the disease and condition haven't interfered much with what I love to do, and I'm tolerating the big 3, so far, reasonably well. Sounds like you're in a similar situation? Your concluding comment about the inconsistency of medical advice relying on research is well-taken. I have read that one should turn hot water heaters up to 130 degrees in order to kill the mycobacteria, but hadn't heard about boiling drinking water. That sounds excessive. I wish you well and, again, am grateful for your reply. (I'm relieved. 🙂 )

Hi. I use 7%. Here’s my background: I am 80. I was dx’d w NTM and BE back in 2012 and tolerated (with difficulty and no ocular side effects) the Big Three. Since that time and until recently I have walked long enough, far enough and briskly enough that there appeared to be no need to nebulize w saline. However COVID changed all that (dx’d 3 times, the first 2 not bad but the third last summer was awful) as did a broken bone in my foot. I have experienced at least two lung infections a year (zapped with AMOC-CLAV) and this past Fall after going through that bad infection last summer and again some virus this Spring I now need oxygen supplementation above 7,500 feet. So I started up the nebulizer with 7% and participated in an 18 session pulmonary rehab program. Then this past May I also needed a total hysterectomy so another fitness setback. Anyway, to conclude, I find the 7% saline to be very helpful and I cough much less during the day (rarely if at all) and night. I do gargle with salt water before I go to bed and that helps a lot - no coughing. *****Also, my pulmonologist recently told me that the MAC/NTM do not “like” the saline treatment and studies are showing the infection recedes. I will have another CT scan this coming hear and hope to learn that indeed my BE has stabilized and the MAC nodules are disappearing. One already did. Hope this helps.

Wow. I had no idea that there isn't solid evidence for AC. I asked my new best friend, ChatGPT5 Plus, to find and summarize the evidence and you are right, bayarea 58.
What perplexes me now that I've learnt this is why bronchiectasis and MAC docs push
AC so hard; in videos I've seen them quip "the three most important things determining bronchiectasis outcomes are airway clearance, airway clearance, and airway clearance."
Now I want to emphasize that it's hard to get good data in large studies etc, so we all should keep doing whatever our docs recommend.
But I can't help think of other things docs pushed until sufficiently rigorous studies disproved them; as a woman, me and every woman I knew was popping calcium chews daily, for years, until any meaningful positive impact on bone health from such supplements was debunked. Ditto Vitamin E for heart health and you must drink 64 oz of water a day.
If I were a cynic (I'm not), I'd wonder if the medical profession inadvertently likes to have something to put the onus on patients not taking their calcium or whatever.
I'm going to ask my docs about this but I don't think they will like it 🙂

You are correct that I've never had positive MAC cultures and have bronchiectasis. My CT's had trees-in-bud, mucus plugs, ground glass, etc that caused them to think I had MAC. The theories for those abnormal findings is that it was from my significant sinus issues with PND or that I'd had MAC and cleared it without treatment.

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.

Hi, I had tree in bud nodules on CT scans for over 2 years, but negative broncoscopy (x2) results for MAC, which they suspected. I usually get at least one respiratory infection per year, last year 2. This Feb/March I had pneumonia twice. Repeat broncoscopy and a sputum test both were positive for MAC in May and June. I had started with a flutter valve last year but only when feeling sick. In June I started nebulizing albuteral, Brevespi inhaler, then flutter valve twice per day. Did ok with that. Then Pulm added in nebulizer 3% saline after official diagnoses in June … coughed up a lot more slime balls! Lots of ‘gunk’ coming out with the saline and finally felt like I was breathing better! After meting with ID in July , I asked him about a study with 7% saline. He said hadn’t heard about it but ask Pulm. She already had a rx called in before I got home to message her. At first I felt like it helped me cough up more. Now I feel my lungs are much clearer so not really coughing up anything except clear, bubbly what I’m assuming is saline slime. LOL. Not sure how else to explain it. I go for another sputum test in Sept. then ID dr in Oct. I’ll post once they grow the sputum test and I get results. Praying for a much lower bacterial load! Trying to not have to do the big 3. Interesting thing ID dr at Mayo said: If the saline helps get the number of bacteria down low enough then maybe your immune system can take care of the rest. And the study I’d asked about specifically looked at the ability of various mycobacterium and what percent saline environment they can survive in. MAC was 5.5%. So if nebbing 7% doesn’t hurt anything, I’m all for trying it. I get a little “raspy” sounding for about 30 min. Afterwards but then feel good. I’ll update again in Oct. when test results are back.