Current perspectives on hypertonic saline therapy in bronchial obstructive airway diseases
DOI:
https://doi.org/10.15574/SP.2026.1(153).2933Keywords:
children, bronchial obstructive syndrome, hypertonic saline solutions, hyaluronic acid, mucociliary clearance, inhalation therapyAbstract
Bronchial obstruction syndrome (BOS) is one of the most pressing clinical issues worldwide, particularly in paediatrics. It is associated with acute respiratory viral infections, obstructive bronchitis and allergic respiratory conditions, including bronchial asthma. This significantly worsens the quality of life of the child, increasing the risk of hospitalization and the need for emergency care.
Aim - to evaluate current approaches to the use of hypertonic saline solutions in the treatment of bronchial obstruction syndrome in children, with an emphasis on the effect on mucociliary clearance, clinical outcomes, and tolerability of therapy.
The pathogenesis of BOS includes excessive formation and increased viscosity of bronchial secretions, mucosal edema and bronchospasm, which leads to impaired mucociliary clearance (MCC) and worsens respiratory failure. In this regard, an important task of modern therapy is to restore MCC and eliminate excessive secretion. Hypertonic saline solutions (HSS) have proven their effectiveness in moisturizing the mucous membrane of the respiratory tract, reducing the viscosity of sputum and improving its discharge. Clinical studies have shown that the use of HSS in children with acute and chronic airway obstruction contributes to faster symptom relief, reduced need for bronchodilators and reduced duration of hospitalization. Of particular interest is the combination of HSS with hyaluronic acid (HA). Due to the anti-inflammatory and moisturizing properties of HA, such a combination (for example, LORDE® hyal) increases tolerance to inhalations, reduces the risk of bronchospasm and enhances the therapeutic effect. In children with acute bronchial obstruction, the use of HSS + HA already on the 3rd day provides clinical improvement, the appearance of productive cough and a reduction in the duration of the disease.
Conclusions. Inhalation therapy with HSS, especially in combination with HA, is an effective and safe method in the treatment of BOS. Further multicenter studies are needed to optimize the use regimens and evaluate long-term effects.
No conflict of interests was declared by the authors.
References
Allegra L, Patrona SD, Petrigni G. (2012). Hyaluronic acid: Perspectives in lung diseases. Handb. Exp. Pharmacol. 207: 385-340. https://doi.org/10.1007/978-3-642-23056-1_17; PMid:22566234
Anderson WH, Coakley RD, Button B et al. (2015). The relationship of mucus concentration (hydration) to mucus osmotic pressure and transport in chronic bronchitis. Am J Respir Crit Care Med. 192: 182-190. https://doi.org/10.1164/rccm.201412-2230OC; PMid:25909230 PMCid:PMC4532825
Bennett WD, Henderson AG, Ceppe A et al. (2020). Effect of hypertonic saline on mucociliary clearance and clinical outcomes in chronic bronchitis. ERJ Open Res. 6: 00269-2020. https://doi.org/10.1183/23120541.00269-2020; PMid:32802823 PMCid:PMC7418818
Bennett WD, Burbank A, Almond M, Wu J, Ceppe A, Hernandez M et al. (2021, Jun 7). Acute and durable effect of inhaled hypertonic saline on mucociliary clearance in adult asthma. ERJ Open Res. 7(2): 00062-2021. https://doi.org/10.1183/23120541.00062-2021; PMid:34109248 PMCid:PMC8184161
Biju T, Rutman A, Hirst RA et al. (2010). Ciliary dysfunction and ultrastructural abnormalities are features of severe asthma. J Allergy Clin Immunol. 126: 722-729. https://doi.org/10.1016/j.jaci.2010.05.046; PMid:20673980
Buonpensiero P, De Gregorio F, Sepe A, Di Pasqua A, Ferri P, Siano M et al. (2010). Hyaluronic acid improves "pleasantness" and tolerability of nebulized hypertonic saline in a cohort of patients with cystic fibrosis. Adv. Ther. 27: 870-878. https://doi.org/10.1007/s12325-010-0076-8; PMid:20953746
Carlier FM, de Fays C, Pilette C. (2021, Jun 24). Epithelial Barrier Dysfunction in Chronic Respiratory Diseases. Front Physiol. 12: 691227. https://doi.org/10.3389/fphys.2021.691227; PMid:34248677 PMCid:PMC8264588
Cresta F, Naselli A, Favilli F, Casciaro R. (2013, Apr 29). Inhaled hypertonic saline+hyaluronic acid in cystic fibrosis with asthma-like symptoms: a new therapeutic chance. BMJ Case Rep. 2013: bcr2013009042. https://doi.org/10.1136/bcr-2013-009042; PMid:23632183 PMCid:PMC3645254
Crisan-Dabija R, Sandu IG, Popa IV, Scripcariu DV, Covic A, Burlacu A. (2021, Nov 22). Halotherapy-An Ancient Natural Ally in the Management of Asthma: A Comprehensive Review. Healthcare (Basel). 9(11): 1604. https://doi.org/10.3390/healthcare9111604; PMid:34828649 PMCid:PMC8623171
Daviskas E, Anderson SD, Young IH. (2007). Inhaled mannitol changes the sputum properties in asthmatics with mucus hypersecretion. Respirology. 12: 683-691. https://doi.org/10.1111/j.1440-1843.2007.01107.x; PMid:17875056
Donaldson SH, Bennett WD, Zeman KL et al. (2006). Mucus clearance and lung function in cystic fibrosis with hypertonic saline. N Engl J Med. 354: 241-250. https://doi.org/10.1056/NEJMoa043891; PMid:16421365 PMCid:PMC6837306
Fahy JV, Dickey BF. (2010). Airway mucus function and dysfunction. N Engl J Med. 363: 2233-2247. https://doi.org/10.1056/NEJMra0910061; PMid:21121836 PMCid:PMC4048736
Goralski JL, Wu D, Thelin WR et al. (2018). The in vitro effect of nebulised hypertonic saline on human bronchial epithelium. Eur Respir J. 51: 1702652. https://doi.org/10.1183/13993003.02652-2017; PMid:29599187 PMCid:PMC6000726
Henderson AG, Ehre C, Button B et al. (2014). Cystic fibrosis airway secretions exhibit mucin hyperconcentration and increased osmotic pressure. J Clin Invest. 124: 3047-3060. https://doi.org/10.1172/JCI73469; PMid:24892808 PMCid:PMC4072023
Ilchenko S, Fialkovska A, Cherhinets V, Skriabina K. (2021). Comparison of the efficacy and tolerability of inhaled hypertonic salines of sodium chloride in pediatric practice. Med. perspekt. 26(1): 136-142. https://doi.org/10.26641/2307-0404.2021.1.227953
Ilchenko SI, Fialkovska AO, Skriabina KV, Ivanus SH. (2022). Reaktyvnist bronkhiv na inhaliatsiy̆ni solovi hipertonichni rozchyny u ditey̆ z mukovistsydozom. Zdorov'ia dytyny. 17: 5. https://doi.org/10.22141/2224-0551.17.5.2022.1523
Kuyper LM, Paré PD, Hogg JC et al. (2003). Characterization of airway plugging in fatal asthma. Am J Med. 115: 6-11. https://doi.org/10.1016/S0002-9343(03)00241-9; PMid:12867228
Lăzărescu H, Simionca I, Hoteteu M, Mirescu L. (2014). Speleotherapy - modern biomedical perspectives. J. Med. Life. 7: 76-79.
Loughlin CE, Esther CR Jr, Lazarowski ER, Alexis NE, Peden DB. (2010). Neutrophilic inflammation is associated with altered airway hydration in stable asthmatics. Respiratory Medicine. 104: 29-33. https://doi.org/10.1016/j.rmed.2009.07.002; PMid:19646854 PMCid:PMC2818060
Okhotnikova OM. (2019). Suchasni metody usunennia bronkhoobstruktyvnoho syndromu u ditei. Zdorov'ia Ukrainy. Pediatriia. 4(51).
Okhotnikova YeN, Duda LV. (2017). Obstructive bronchitis: is this pathology simple in children? Sovremennaya pediatriya. 6(86): 87-96. https://doi.org/10.15574/SP.2017.86.87
Porsbjerg C, Melén E, Lehtimäki L, Shaw D. (2023). Asthma. Lancet. 401(10379): 858-3. https://doi.org/10.1016/S0140-6736(22)02125-0; PMid:36682372
Ros M, Casciaro R, Lucca F, Troiani P, Salonini E, Favilli F et al. Hyaluronic acid improves the tolerability of hypertonic saline in the chronic treatment of cystic fibrosis patients: a multicenter, randomized, controlled clinical trial. J Aerosol Med Pulm Drug Deli. 27(2): 133-137. Epub 2013 Jun 8. https://doi.org/10.1089/jamp.2012.1034; PMid:23745525
Trimble AT, Whitney Brown A, Laube BL et al. (2018). Hypertonic saline has a prolonged effect on mucociliary clearance in adults with cystic fibrosis. J Cyst Fibrosis. 17: 650-656. https://doi.org/10.1016/j.jcf.2018.01.001; PMid:29371133 PMCid:PMC6053331
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