Sodium Chloride 7% (Hypertonic Saline)

How it works

The hyperosmolar solution draws water onto the airway surface, rehydrating the periciliary layer, reducing mucus viscosity and improving mucociliary and cough clearance.

Prescribing in practice

• Inhalation commonly provokes bronchospasm, cough and chest tightness, so a test dose should be supervised and a bronchodilator given beforehand in those at risk.
• Where co-prescribed with inhaled dornase alfa or antibiotics, separate the nebulised treatments and follow a logical airway-clearance order rather than mixing solutions.
• Pre-treatment with a short-acting bronchodilator before each dose is advised where airway reactivity is a concern.

Monitoring

Monitor tolerability of the first supervised dose with assessment of bronchospasm and, where indicated, spirometry before and after inhalation.

Counselling the patient

• Use a bronchodilator beforehand if advised and stop if you develop marked wheeze or breathlessness.
• Clean and dry the nebuliser after every use to reduce infection risk.

Evidence & guidelines

Nebulised hypertonic saline is supported by cystic fibrosis trial evidence and NICE/CF guidance showing improved clearance and modest lung-function benefit.