Hypertonic Saline Improves Mucociliary Clearance in Stable, Mild-Moderate chronic bronchitis

 Ashley G. Henderson, William D. Bennett, Kirby L. Zeman, Richard C. Boucher; University of North Carolina at Chapel Hill, Division of Pulmonary/Critical Care, CB #7020, Chapel Hill, NC  27599, USA

Mucociliary clearance (MCC), a key component of airway defense, is impaired in chronic bronchitis (CB) due to chronic cigarette smoke exposure. We hypothesized that these patients have dehydrated airway surface mucus which might be rehydrated by inhalation of aerosolized, 7% hypertonic saline (HS) to acutely improve MCC.  To test this hypothesis and the safety of HS in CB, we measured MCC in mild to moderate CB (n=3) (average FEV1/FVC ratio 55%) using gamma scintigraphy following inhalation of Technetium99m-labeled particles.  MCC (right lung retention vs. time over a 90 minute period) was measured twice in each subject: baseline and immediately after the inhalation of 7% HS (5ml in Pari LC Star jet nebulizer). Baseline MCC was slow but pretreatment with 7% HS caused an acute acceleration, mean retention of 0.97 vs. 0.86 (baseline vs. HS, respectively) at 30 minutes.  In addition, there was an acceleration of clearance through 24-hours, mean retention of 0.55 vs. 0.43 (baseline vs. HS, respectively).  HS was well tolerated with no change in spirometry values tested 5 minutes and 2 h after inhalation.  These preliminary data suggest that inhaled HS is well tolerated in mild-moderate CB and can enhance mucus clearance, potentially reducing susceptibility to acute exacerbations.

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