Hypertonic saline solution in the treatment of respiratory diseases Review article
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Published:
Sep 16, 2020
Keywords:
hypertonic saline solution, common cold, allergic rhinitis, rhinosinusitis, bronchiolitis, cystic fibrosis, bronchiectasis, nebulization
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Abstract
Evidence of the efficacy of hypertonic saline solutions in the common cold, allergic rhinitis, rhinosinusitis, bronchiolitis, cystic fibrosis, and bronchiectasis in children and adults is presented based on systematic reviews with meta-analysis and studies published in journals with impact factor.
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Emeryk , A., Emeryk-Maksymiuk , J., Janeczek , K., & Jędrzejewski , A. (2020). Hypertonic saline solution in the treatment of respiratory diseases. Alergoprofil, 16(3), 10-17. https://doi.org/10.24292/01.AP.163160920
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THERAPY
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Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
References
1. https://en.wikipedia.org/wiki/Nasal_irrigation. (Access: 28.07.2020).
2. Wingrave W. The nature of discharges and douches. Lancet. 1902; 159: 1373-5.
3. Kassel JC, King D, Spurling GK et al. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev. 2010; 3: CD006821.
4. Emeryk A, Pirożyński M. Nebulizacja: czym, jak, dla kogo, kiedy? Polski Konsensus Nebulizacyjny. Medycyna Praktyczna – Pneumonologia. 2013; 1; wydanie specjalne: 2-8.
5. Rabago D, Zgierska A. Saline Nasal Irrigation for Upper Respiratory Conditions. Am Fam Physician. 2009; 80(10): 1117-9.
6. Rapiejko P, Wojdas A, Ratajczak J et al. Techniques of intranasal drug use. Pol Mer Lek. 2005; 19(111): 400-2.
7. Rapiejko P, Lipiec A. Płukanie czy nawilżanie? Alergoprofil. 2011; 7(1): 5-9.
8. Balsamo R, Lanata L, Egan CG. Mucoactive drugs. Eur Respir Rev. 2010; 19: 127-33.
9. Linssen RSN, Ma J, Bem RA et al. Rational use of mucoactive medications to treat pediatric airway disease. Paed Respir Rev. 2020. https://doi.org/10.1016/j.prrv.2020.06.007 (in press).
10. Kirkpatrick GL. The common cold. Prim Care. 1996; 23(4): 657-75.
11. King D, Mitchell B, Williams ChP et al. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev. 2015; 4: CD006821.
12. van Driel ML, Scheire S, Deckx L et al. What treatments are effective for common cold in adults and children? BMJ. 2018; 363: k3786.
13. Ramalingam S, Graham C, Dove J et al. A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold. Sci Rep. 2019; 9: 1015.
14. Ramalingam S, Graham C, Dove J et al. Hypertonic saline nasal irrigation and gargling should be considered as a treatment option for COVID-19. J Glob Health. 2020; 10(1): 010332.
15. Head K, Snidvongs K, Glew S et al. Saline irrigation for allergic rhinitis. Cochrane Database Syst Rev. 2018; 6: CD012597.
16. Li CL, Lin HC, Lin CY et al. Effectiveness of Hypertonic Saline Nasal Irrigation for Alleviating Allergic Rhinitis in Children: A Systematic Review and Meta-Analysis. J Clin Med. 2019; 8(1): 64.
17. Malizia V, Fasola S, Ferrante G et al. Efficacy of Buffered Hypertonic Saline Nasal Irrigation for Nasal Symptoms in Children with Seasonal Allergic Rhinitis: A Randomized Controlled Trial. Int Arch Allergy Immunol. 2017; 174: 97-103.
18. Di Berardino F, Zanetti D, D’Amato G. Nasal rinsing with an atomized spray improves mucociliary clearance and clinical symptoms during peak grass pollen season. Am J Rhinol Allergy. 2017; 31: 40-3.
19. Rapiejko P, Jurkiewicz D. Wpływ stosowania roztworu izotonicznego wody morskiej (Marimer) na objawy chorobowe oraz stan błony śluzowej nosa u chorych z uczuleniem na alergeny pyłku roślin. Alergoprofil. 2007; 3: 29-35.
20. Samoliński B, Arcimowicz M (ed). Polskie Standardy Leczenia Nieżytów Nosa (PoSLeNN). Stanowisko Panelu Ekspertów Polskiego Towarzystwa Alergologicznego. Alerg Pol. 2013; numer specjalny S1: 17-167.
21. Fokkens WJ, Lund VJ, Mullol J. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012; 23: 1-298.
22. Bachert C, Pawankar R, Zhang L et al. ICON: chronic rhinosinusitis. World Allergy Organ J. 2014; 7: 25.
23. Chon LY, Head K, Hopkins C et al. Saline irrigation for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016; 4: CD011995.
24. Kanjanawasee D, Seresirikachorn K, Chitsuthipakorn W et al. Hypertonic saline versus isotonic saline nasal irrigation: systematic review and meta-analysis. Am J Rhinol Allergy. 2018; 32(4): 269-79.
25. Jadczak M. Miejsce preparatów umożliwiających płukanie jam nosa w praktyce laryngologicznej. Pol Przegl Otorynolaryngol. 2013; 2: 226-9.
26. Liu L, Pan M, Li Y et al. Efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis: systematic review and meta-analysis. Braz J Otorhinolaryngol. 2020; 16: S1808-8694.
27. Nimsakul S, Ruxrungtham S, Chusakul S et al. Does Heating up Saline for Nasal Irrigation Improve Mucociliary Function in Chronic Rhinosinusitis? Am J Rhinol Allergy. 2018; 32(2): 106-11.
28. Wills P, Greenstone M. Inhaled hyperosmolar agents for bronchiectasis. Cochrane Database Syst Rev. 2002; 1: CD002996.
29. Elkins MR, Robinson M, Rose BR et al. National Hypertonic Saline in Cystic Fibrosis (NHSCF) Study Group. A controlled trial of long-term inhaled hypertonic saline in patients with cystic fibrosis. N Engl J Med. 2006; 354: 229-40.
30. Jones AP, Wallis CE. Recombinant human deoxyribonuclease for cystic fibrosis. Cochrane Database Syst Rev. 2003; 3: CD001127.
31. Lin HL, Chiu LH, Wan GW et al. Hypertonic saline enhances the efficacy of aerosolized gentamicin against Pseudomonas aeruginosa. Sci Rep. 2020; 10: 4325.
32. Wark P, McDonald VM. Nebulised hypertonic saline for cystic fibrosis. Cochrane Database Syst Rev. 2018; 9(9): CD001506.
33. Mogayzel PJ, Naureckas ET, Robinson KA et al. Cystic fibrosis pulmonary guidelines. Am J Respir Crit Care Med. 2013; 187: 680-9.
34. Castellani C, Duff AJA, Bell SC et al. ECFS best practice guidelines: the 2018 revision. J Cystic Fibrosis. 2018; 17: 153-78.
35. Sands D, Walicka-Serzysko K, Doniec Z et al. ReKOMendacje Postępowania w MukowiScydozie (cystic fibrosis – CF) dla lekarzy POZ – KOMPAS CF. Ped Pol. 2017; 92: 431-45.
36. Nicolson CH, Stirling RG, Borg BM et al. The long term effect of inhaled hypertonic saline 6% in non-cystic fibrosis bronchiectasis. Respir Med. 2012; 106: 661-7.
37. Benjamin J, Tarrant BJ, Le Maitre C et al. Mucoactive agents for chronic, non-cystic fibrosis lung disease: A systematic review and meta-analysis. Respirology. 2017; 22: 1084-92.
38. Pasteur MC, Bilton D, Hill AT. On behalf of the British Thoracic Society Bronchiectasis (non-CF) Guideline Group. British Thoracic Society guideline for non-CF bronchiectasis. Thorax. 2010; 65: 1-58.
39. Máiz L, Girón RM, Prats E et al. Addition of hyaluronic acid improves tolerance to 7% hypertonic saline solution in bronchiectasis patients. Ther Adv Respir Dis. 2018; 12: 1753466618787385.
40. Wabnitz DA, Wormald PJ. A blind, randomized, controlled study on the effect of buffered 0.9 and 3% sodium chloride intranasal sprays on ciliary beat frequency. Laryngoscope. 2005; 115: 803-5.
41. Sood N, Bennett WD, Zeman K et al. Increasing concentration of inhaled saline with or without amiloride: effect on mucociliary clearence in normal subjects. Am J Respir Crit Care Med. 2003; 167: 158-63.
42. Zhang L, Mendoza-Sassi RA, Wainwright C et al. Nebulized hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev. 2008; 4: CD006458.
43. Ralston SL, Lieberthal AS, Meissner HC et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. American Academy of Pediatrics. Pediatrics. 2014; 134(5): e1474-e1502.
44. Hryniewicz W, Albrecht P, Radzikowski A. Rekomendacje postępowania w pozaszpitalnych zakażeniach układu oddechowego. Narodowy Instytut Leków, Warszawa 2016.
45. Chen YJ, Lee WL, Wang CM et al. Nebulized hypertonic saline treatment reduces both rate and duration of hospitalization for acute bronchiolitis in infants: an updated meta-analysis. Pediatr Neonatol. 2014; 55(6): 431-8.
46. Zhang L, Mendoza-Sassi RA, Klassen TP et al. Nebulized hypertonic saline for acute bronchiolitis: a systematic review. Pediatrics. 2015; 136(4): 687-701.
47. Zhang L, Mendoza-Sassi RA, Wainwright C et al. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev. 2017; 12(12): CD006458.
48. Zhang L, Gunther CB, Franco OS et al. Impact of hypertonic saline on hospitalization rate in infants with acute bronchiolitis: a meta-analysis. Pediatr Pulmonol. 2018; 53(8): 1089-95.
49. Harrison W, Angoulvant F, House S et al. Hypertonic saline in bronchiolitis and type I error: a trial sequential analysis. Pediatrics. 2018; 142(3): e20181144.
50. Kirolos A, Manti S, Blacow R et al. A systematic review of clinical practice guidelines for the diagnosis and management of bronchiolitis. J Infect Dis. 2019; jiz240.
51. Hart A, Sugumar K, Milan SJ et al. Inhaled hyperosmolar agents for bronchiectasis. Cochrane Database Syst Rev. 2014; 5: CD002996.
52. Paff T, Daniels JM, Weersink EJ et al. A randomised controlled trial on the effect of inhaled hypertonic saline on quality of life in primary ciliary dyskinesia. Eur Respir J. 2017; 49: 1601770.
53. Valderramas SR, Atallah AN. Effectiveness and safety of hypertonic saline inhalation combined with exercise training in patients with chronic obstructive pulmonary disease: a randomized trial. Respir Care. 2009; 54: 327-33.
54. Taube Ch, Holz O, Mücke M et al. Airway response to inhaled hypertonic saline in patients with moderate to severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001; 164: 1810-5.
55. https://goldcopd.org/wp-content/uploads/2019/12/GOLD-2020-FINAL-ver1.2-03Dec19_WMV.pdf. (Access: 30.07.2020).
2. Wingrave W. The nature of discharges and douches. Lancet. 1902; 159: 1373-5.
3. Kassel JC, King D, Spurling GK et al. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev. 2010; 3: CD006821.
4. Emeryk A, Pirożyński M. Nebulizacja: czym, jak, dla kogo, kiedy? Polski Konsensus Nebulizacyjny. Medycyna Praktyczna – Pneumonologia. 2013; 1; wydanie specjalne: 2-8.
5. Rabago D, Zgierska A. Saline Nasal Irrigation for Upper Respiratory Conditions. Am Fam Physician. 2009; 80(10): 1117-9.
6. Rapiejko P, Wojdas A, Ratajczak J et al. Techniques of intranasal drug use. Pol Mer Lek. 2005; 19(111): 400-2.
7. Rapiejko P, Lipiec A. Płukanie czy nawilżanie? Alergoprofil. 2011; 7(1): 5-9.
8. Balsamo R, Lanata L, Egan CG. Mucoactive drugs. Eur Respir Rev. 2010; 19: 127-33.
9. Linssen RSN, Ma J, Bem RA et al. Rational use of mucoactive medications to treat pediatric airway disease. Paed Respir Rev. 2020. https://doi.org/10.1016/j.prrv.2020.06.007 (in press).
10. Kirkpatrick GL. The common cold. Prim Care. 1996; 23(4): 657-75.
11. King D, Mitchell B, Williams ChP et al. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev. 2015; 4: CD006821.
12. van Driel ML, Scheire S, Deckx L et al. What treatments are effective for common cold in adults and children? BMJ. 2018; 363: k3786.
13. Ramalingam S, Graham C, Dove J et al. A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold. Sci Rep. 2019; 9: 1015.
14. Ramalingam S, Graham C, Dove J et al. Hypertonic saline nasal irrigation and gargling should be considered as a treatment option for COVID-19. J Glob Health. 2020; 10(1): 010332.
15. Head K, Snidvongs K, Glew S et al. Saline irrigation for allergic rhinitis. Cochrane Database Syst Rev. 2018; 6: CD012597.
16. Li CL, Lin HC, Lin CY et al. Effectiveness of Hypertonic Saline Nasal Irrigation for Alleviating Allergic Rhinitis in Children: A Systematic Review and Meta-Analysis. J Clin Med. 2019; 8(1): 64.
17. Malizia V, Fasola S, Ferrante G et al. Efficacy of Buffered Hypertonic Saline Nasal Irrigation for Nasal Symptoms in Children with Seasonal Allergic Rhinitis: A Randomized Controlled Trial. Int Arch Allergy Immunol. 2017; 174: 97-103.
18. Di Berardino F, Zanetti D, D’Amato G. Nasal rinsing with an atomized spray improves mucociliary clearance and clinical symptoms during peak grass pollen season. Am J Rhinol Allergy. 2017; 31: 40-3.
19. Rapiejko P, Jurkiewicz D. Wpływ stosowania roztworu izotonicznego wody morskiej (Marimer) na objawy chorobowe oraz stan błony śluzowej nosa u chorych z uczuleniem na alergeny pyłku roślin. Alergoprofil. 2007; 3: 29-35.
20. Samoliński B, Arcimowicz M (ed). Polskie Standardy Leczenia Nieżytów Nosa (PoSLeNN). Stanowisko Panelu Ekspertów Polskiego Towarzystwa Alergologicznego. Alerg Pol. 2013; numer specjalny S1: 17-167.
21. Fokkens WJ, Lund VJ, Mullol J. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012; 23: 1-298.
22. Bachert C, Pawankar R, Zhang L et al. ICON: chronic rhinosinusitis. World Allergy Organ J. 2014; 7: 25.
23. Chon LY, Head K, Hopkins C et al. Saline irrigation for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016; 4: CD011995.
24. Kanjanawasee D, Seresirikachorn K, Chitsuthipakorn W et al. Hypertonic saline versus isotonic saline nasal irrigation: systematic review and meta-analysis. Am J Rhinol Allergy. 2018; 32(4): 269-79.
25. Jadczak M. Miejsce preparatów umożliwiających płukanie jam nosa w praktyce laryngologicznej. Pol Przegl Otorynolaryngol. 2013; 2: 226-9.
26. Liu L, Pan M, Li Y et al. Efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis: systematic review and meta-analysis. Braz J Otorhinolaryngol. 2020; 16: S1808-8694.
27. Nimsakul S, Ruxrungtham S, Chusakul S et al. Does Heating up Saline for Nasal Irrigation Improve Mucociliary Function in Chronic Rhinosinusitis? Am J Rhinol Allergy. 2018; 32(2): 106-11.
28. Wills P, Greenstone M. Inhaled hyperosmolar agents for bronchiectasis. Cochrane Database Syst Rev. 2002; 1: CD002996.
29. Elkins MR, Robinson M, Rose BR et al. National Hypertonic Saline in Cystic Fibrosis (NHSCF) Study Group. A controlled trial of long-term inhaled hypertonic saline in patients with cystic fibrosis. N Engl J Med. 2006; 354: 229-40.
30. Jones AP, Wallis CE. Recombinant human deoxyribonuclease for cystic fibrosis. Cochrane Database Syst Rev. 2003; 3: CD001127.
31. Lin HL, Chiu LH, Wan GW et al. Hypertonic saline enhances the efficacy of aerosolized gentamicin against Pseudomonas aeruginosa. Sci Rep. 2020; 10: 4325.
32. Wark P, McDonald VM. Nebulised hypertonic saline for cystic fibrosis. Cochrane Database Syst Rev. 2018; 9(9): CD001506.
33. Mogayzel PJ, Naureckas ET, Robinson KA et al. Cystic fibrosis pulmonary guidelines. Am J Respir Crit Care Med. 2013; 187: 680-9.
34. Castellani C, Duff AJA, Bell SC et al. ECFS best practice guidelines: the 2018 revision. J Cystic Fibrosis. 2018; 17: 153-78.
35. Sands D, Walicka-Serzysko K, Doniec Z et al. ReKOMendacje Postępowania w MukowiScydozie (cystic fibrosis – CF) dla lekarzy POZ – KOMPAS CF. Ped Pol. 2017; 92: 431-45.
36. Nicolson CH, Stirling RG, Borg BM et al. The long term effect of inhaled hypertonic saline 6% in non-cystic fibrosis bronchiectasis. Respir Med. 2012; 106: 661-7.
37. Benjamin J, Tarrant BJ, Le Maitre C et al. Mucoactive agents for chronic, non-cystic fibrosis lung disease: A systematic review and meta-analysis. Respirology. 2017; 22: 1084-92.
38. Pasteur MC, Bilton D, Hill AT. On behalf of the British Thoracic Society Bronchiectasis (non-CF) Guideline Group. British Thoracic Society guideline for non-CF bronchiectasis. Thorax. 2010; 65: 1-58.
39. Máiz L, Girón RM, Prats E et al. Addition of hyaluronic acid improves tolerance to 7% hypertonic saline solution in bronchiectasis patients. Ther Adv Respir Dis. 2018; 12: 1753466618787385.
40. Wabnitz DA, Wormald PJ. A blind, randomized, controlled study on the effect of buffered 0.9 and 3% sodium chloride intranasal sprays on ciliary beat frequency. Laryngoscope. 2005; 115: 803-5.
41. Sood N, Bennett WD, Zeman K et al. Increasing concentration of inhaled saline with or without amiloride: effect on mucociliary clearence in normal subjects. Am J Respir Crit Care Med. 2003; 167: 158-63.
42. Zhang L, Mendoza-Sassi RA, Wainwright C et al. Nebulized hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev. 2008; 4: CD006458.
43. Ralston SL, Lieberthal AS, Meissner HC et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. American Academy of Pediatrics. Pediatrics. 2014; 134(5): e1474-e1502.
44. Hryniewicz W, Albrecht P, Radzikowski A. Rekomendacje postępowania w pozaszpitalnych zakażeniach układu oddechowego. Narodowy Instytut Leków, Warszawa 2016.
45. Chen YJ, Lee WL, Wang CM et al. Nebulized hypertonic saline treatment reduces both rate and duration of hospitalization for acute bronchiolitis in infants: an updated meta-analysis. Pediatr Neonatol. 2014; 55(6): 431-8.
46. Zhang L, Mendoza-Sassi RA, Klassen TP et al. Nebulized hypertonic saline for acute bronchiolitis: a systematic review. Pediatrics. 2015; 136(4): 687-701.
47. Zhang L, Mendoza-Sassi RA, Wainwright C et al. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev. 2017; 12(12): CD006458.
48. Zhang L, Gunther CB, Franco OS et al. Impact of hypertonic saline on hospitalization rate in infants with acute bronchiolitis: a meta-analysis. Pediatr Pulmonol. 2018; 53(8): 1089-95.
49. Harrison W, Angoulvant F, House S et al. Hypertonic saline in bronchiolitis and type I error: a trial sequential analysis. Pediatrics. 2018; 142(3): e20181144.
50. Kirolos A, Manti S, Blacow R et al. A systematic review of clinical practice guidelines for the diagnosis and management of bronchiolitis. J Infect Dis. 2019; jiz240.
51. Hart A, Sugumar K, Milan SJ et al. Inhaled hyperosmolar agents for bronchiectasis. Cochrane Database Syst Rev. 2014; 5: CD002996.
52. Paff T, Daniels JM, Weersink EJ et al. A randomised controlled trial on the effect of inhaled hypertonic saline on quality of life in primary ciliary dyskinesia. Eur Respir J. 2017; 49: 1601770.
53. Valderramas SR, Atallah AN. Effectiveness and safety of hypertonic saline inhalation combined with exercise training in patients with chronic obstructive pulmonary disease: a randomized trial. Respir Care. 2009; 54: 327-33.
54. Taube Ch, Holz O, Mücke M et al. Airway response to inhaled hypertonic saline in patients with moderate to severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001; 164: 1810-5.
55. https://goldcopd.org/wp-content/uploads/2019/12/GOLD-2020-FINAL-ver1.2-03Dec19_WMV.pdf. (Access: 30.07.2020).