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Is it possible to nebulize too much hypertonic saline?

Posted by bronchiectasaurus @bronchiectasaurus, Aug 15 9:45pm

I'm getting a LOT of 7% saline in my lungs with my new Pari eRapid system, and more mucus is moving. But I wonder if it's overkill. Will saline lose efficacy when I'm actually ill with a respiratory infection, if I inhale this much twice a day when I'm relatively healthy? How much hypertonic saline is too much?

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kathyjjb | @kathyjjb | Aug 17 11:22am
In reply to @pacathy "I haven't had positive MAC cultures, but do daily albuterol neb and airway clearance for bronchiectasis..." + (show)
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I haven't had positive MAC cultures, but do daily albuterol neb and airway clearance for bronchiectasis and mild asthma.

I had repeated viral infections 2 winters ago (young grandchildren) and last fall my pulmonologist suggested I try 7% saline a few times/week to see if that would help prevent them. I did it and haven't had any since November. Coincidence or cause? I don't know, but docs are using hypertonic saline even with negative sputum.

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I would bet cause. have mild to moderate BE and mild asthma or reactive airway disease. NJH and my local doc don't agree about me having asthma. I was diagnosed with MAB back in November and started nebulizing with 7%. My ID doctor suggested I go to 3% but both my local pulmonary doctor and NJH ID stressed I needed to get back on 7%, which I did. I do not get infections like I used to while I'm nebulizing, so I will continue twice per day for maybe 12 months after l I get 3 negative MAB cultures and then maybe reduce to 1/day or less for prevention. I'm just not sure and want to get more stats on how long it takes to go from culture conversion to cured. I have taken a lot of precautions in the home to avoid reinfection.
A few times, I felt like I was coming down with something and I just kept up with my daily nebulizing and exercising and the feelings passed. I plan on nebulizing for the rest of my life-just not sure of frequency-yet. So far, I got my first negative MAB culture and now my 2nd culture is negative after 3 weeks of incubation. MAB is fast growing-faster than MAC, so I'm hopeful.

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pacathy | @pacathy | Aug 18 5:52am

I'm hoping cause. I'm on a little trip with dau and g-children. I brought my nebulizer-I don't always on trips. I was explaining to daughter that I brought it because they've been sick and I don't want to miss the 7 % saline. She said she wants some. : ). We joked the kids should take a few puffs before school everyday.
That's great news about negative cultures! Hoping pending one is, too!

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bayarea58 | @bayarea58 | Aug 19 12:03pm
In reply to @kathyjjb "Agree, we need more studies on the impact of inhaled saline NTMs. Does anyone know how..." + (show)
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Agree, we need more studies on the impact of inhaled saline NTMs. Does anyone know how many years the BE/NTM clinics have been pushing saline inhalation for BE and NTM? I've been told and have read that spontaneous culture conversion occurs in 10-15% of people with BE and NTM. The few studies I have seen on inhaled saline as a treatment showed a much higher rate of culture conversion. Also, how long is recommended to nebulize 2/day after culture conversion. Though I will always nebulize with BE for prevention, it would be interesting to see how many months or range of months to get one from culture conversion to cured (of the original infection). The Portland/NYU Langone study on inhaled saline treatment for those with NTMs, will hopefully start soon.

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@kathyjjb what studies are you referring to re the rate of culture conversion with the use of saline and NTM? I have only seen one study specific to saline and NTM and the culture conversion rate was (off the top of my head) 12% which is consistent with the known data on spontaneous conversion. Interested in reading any other studies out there on saline and NTM. Thanks.

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kathyjjb | @kathyjjb | Aug 19 9:05pm

I posted one recently, I'll repost-see attached below. The other one, was an older UK study that used 6% saline. I just got into Denver for my follow up, so will look for it when I get a chance.

The only problem with this one, is the study group is small. It will be interesting to see the Portland/NYU study results, hopefully, later this year. The downside to that study is it's only 3 months.

What study are you referring to?

Shared files

Outcomes of hypertonic saline inhalation as a treatment modality in nontuberculous mycobacterial pulmonary disease _ European Respiratory Society (Outcomes-of-hypertonic-saline-inhalation-as-a-treatment-modality-in-nontuberculous-mycobacterial-pulmonary-disease-_-European-Respiratory-Society-1.pdf)

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