I am a scientist with a degree in Physiology and I happen to have Cystic
Fibrosis.
From my teenage years and up until recently, I have been nebulising
Colomycin or Tobramycin every day, to try and keep my lungs free from
infection. However as the years passed by I was noticing that my chest
seemed to be getting progressively worse with a decline in lung function.
Even a recent admission for intravenous antibiotics did not produce
the improvement I hoped for.
On my latest visit to my CF specialist in Brisbane, Dr Scott Bell,
I noticed a newspaper clipping on the wall with an article about Australian
surfers with CF. It stated that people with CF who surfed every day
suffered very little lung disease because of all the salt spray they
breathe in.
I mentioned my interest in the article to my CF specialist and asked
if I could try a salt spray treatment for myself. He instructed the
hospital pharmacy to make up a hypertonic saline solution (7g
sodium chloride in 100ml sterile water), which I then nebulised (5ml).
The effects were instant and dramatic - thick, viscous bronchial secretions
that I had previously not been able to clear, came away easily and with
the consistency of water following this simple, drug-free treatment.
I have continued to nebulise the solution every morning for over a
month now and have enjoyed a clear chest throughout. My lung function
has also increased, so I am obviously extremely happy with the outcome.
It’s like a daily dip in the ocean from the comfort of your own
home!
From subsequent internet searches, I have found many scientific research
papers advocating the use of nebulised hypertonic saline rather than
the usual isotonic (0.9%) saline, as a more beneficial solution in treating
diseases of impaired mucociliary clearance, such as bronchiectasis,
asthma, and cystic fibrosis.
The physiology of osmosis behind this principle makes sense, as the
salty solution simply ‘draws’ water out of the cells lining
the lungs, making secretions less sticky and easier to shift. Studies
have shown that hypertonic saline has very comparable effects to Pulmozyme made by Roche (very expensive treatment at $75/vial).
At the moment you cannot obtain vials of hypertonic saline in the correct
strength for nebulising (7%); only plastic vials of 0.9% or 20% sodium
chloride are available. I currently mix my own solution by drawing up
1ml of 20% saline and 2ml of water for injection in a 5ml syringe. However
I have written to AstraZeneca to suggest they include 5ml vials of 7%
saline in their range, as this would make it much more convenient to
nebulise.
I hope my experiences may be useful to others.
Lucy Boden (May 2004) lucyboden @ optusnet.com.au
Update February 2005:
I had no response from AstraZeneca about my idea for a 5ml vial of 7%
NaCl. It would certainly make life simpler. I continue to have my healthiest
year ever with no infections, thanks to hypertonic saline. It would
be great if my article could help others achieve such a good outcome.
It is so simple and cheap that even patients in the poorest countries
can give it a try.
My Brisbane (Australia) specialist has got many CF patients on the
therapy now.
They are also just starting a trial comparing Hypertonic saline with
Mannitol (another mucolytic osmotic agent).
Editors note: For a list of the references please contact us
at editor @ cfww.org and check: http://www.ncbi.nih.gov/PubMed
The drug company that takes on the challenge of producing a
simple form of nebulized hypertonic saline will earn the gratitude of
thousands of CF patients.
Comment on Lucy Boden’s letter
Dieter W Rossboth, MD
Institute of Environmental Medicine, Head
A-1082 Vienna – Austria
Europe
dieter @ rossboth.at
Lucy Boden vividly describes her experiences with cystic fibrosis.
She describes a successive deterioration in her lung function until
she began using Inhaled Hypertonic Salt Solution (IHSS). She describes
that she can personally report beneficial effects since using IHSS daily
for one month. She also provides some scientific proof for the efficacy
of IHSS, citing relevant scientific literature. She also brings to our
attention the finding that CF patients regularly surfing in the sea
in Australia, have reported significant improvement in chest symptoms.
IHSS provokes irritation of the bronchial system and stimulates mucus
excretion through coughing, as a physiologic reaction to IHSS. This
effect is also useful for obtaining sputum from the bronchial system
and deeper parts of the lungs for diagnosis of various diseases, such
as tuberculosis and other infective and non-infective lung diseases.
IHSS also provokes activation of the body’s inflammatory or defence
system and broncho-constriction (narrowing of bronchi), therefore, great
caution is needed in patients with asthma – IHSSs can provoke
asthma attacks in the asthmatic patients!
Used as a complementary therapy, IHSS may well support antibiotic therapy
and help cure infective lung diseases in children (Mandelberg 2003,
Sarrell 2002). Evidence for beneficial effects of IHSS in patients with
cystic fibrosis is however weak, with only a few publications dealing
with IHSS in CF patients and conclusions are noncommittal (e.g. Daviskas
2002, Hirsh 2002, Robinson 1997, Rodwell 1996, Riedler 1996).
It is important that decision making in medicine adheres to “Evidence
Based Medicine” which is derived from analysing the results of
well designed Epidemiological (the study of occurrence and distribution
of diseasse) studies and/or controlled clinical trials. The Cochrane
Database is one of the main tools for processing information from epidemiologic
studies and clinical trials. At this time, the Cochrane Database provides
insufficient data for broad support for recommending the use of IHSS
for therapy in CF patients. Reviewers of the Cochrane Database state
that currently there is insufficient evidence for support of use of
IHSS as routine treatment for people with cystic fibrosis (Wark 2003,
Wark 2000). There is also insufficient evidence for support of the use
of IHSS as routine treatment for various pathologic lung conditions
(Wills 2002, Wills 2001).
Conclusions: At this point in time, the use of IHSS
in CF patients is a matter of the patient’s own responsibility!
Generally, severe or harmful effects of IHSS in non-asthmatic patients
are not likely. CF patients should keep expectations realistic and make
sure that IHSS is conducted under professional medical supervision.
More detailed research on this specific topic is greatly needed. Hygiene
aspects of inhalation therapy are generally of key importance for the
CF patient, and these are described in more detail elsewhere (Rossboth,
IACFA Newsletter 2001; 60: 5-12).
Personally, I appreciate any tools that strengthen patients’
responsibility and support their personal involvement.
