From the Guidelines
Nebulized 3% hypertonic saline is recommended for patients with viscous secretions, as it can help thin mucus secretions and make them easier to clear through coughing or suctioning, as stated in the British Thoracic Society guideline for bronchiectasis in adults 1. The recommended dosage is typically 3-4 mL of 3% sodium chloride solution administered via nebulizer 2-4 times daily.
- Treatment duration varies based on clinical response, but is often continued as needed for symptom management.
- The nebulization should be delivered using a standard jet nebulizer with an appropriate face mask or mouthpiece, with each session lasting approximately 10-15 minutes until the solution is completely nebulized.
- Hypertonic saline works by drawing water into the airway through osmosis, which helps thin mucus secretions and makes them easier to clear through coughing or suctioning.
- This treatment is particularly useful for conditions like cystic fibrosis, bronchiectasis, and COPD with thick secretions, as supported by the British Thoracic Society guideline for bronchiectasis in adults 1.
- Patients may experience bronchospasm, especially those with reactive airways, so pre-treatment with a bronchodilator like albuterol may be beneficial, as suggested in the guideline 1.
- Some patients may also experience throat irritation, cough, or temporary increase in secretions during initial treatments.
- Adequate hydration should be maintained during therapy to optimize mucus clearance, as recommended in the guideline 1.
From the Research
Nebulization Normal Saline 3% for Secretions
- The use of nebulized hypertonic saline (3%) has been studied in various respiratory conditions, including acute bronchiolitis and asthma, to aid in the clearance of secretions.
- A study published in 2022 2 found that nebulized hypertonic saline (3%) was as effective as normal saline (0.9%) and salbutamol nebulization in treating acute bronchiolitis in children.
- Another study published in 2024 3 compared the effectiveness of nebulized 3% saline versus normal saline in reducing the incidence of mucus plugging in adult patients with central airway stents, and found that nebulized 3% saline may be equally or more effective than normal saline.
- A study published in 2010 4 found that high volume normal saline alone was as effective as nebulized salbutamol-normal saline, epinephrine-normal saline, and 3% saline in mild bronchiolitis.
- However, a study published in 2013 5 found that nebulized 3% hypertonic saline was not superior to 0.9% saline in infants with acute bronchiolitis.
- In terms of bronchodilator response, a study published in 2021 6 found that albuterol nebulized with 3% hypertonic saline produced a greater bronchodilator response than albuterol nebulized with normal saline in asthmatic children.
Key Findings
- Nebulized hypertonic saline (3%) may be effective in aiding the clearance of secretions in various respiratory conditions.
- The effectiveness of nebulized hypertonic saline (3%) compared to normal saline (0.9%) may vary depending on the specific condition being treated.
- Further studies are needed to fully understand the benefits and limitations of nebulized hypertonic saline (3%) for secretions.