Purpose of review: The beneficial effect of a short course of nebulized hypertonic saline on lung function for people with cystic fibrosis was first identified in 1996. At that time, competing hypotheses about the pathogenesis of cystic fibrosis lung disease predicted very different responses to long-term inhalation of hypertonic saline.
Recent findings: Recent benchtop research supports the hypothesis that the liquid layer lining the airways is depleted in cystic fibrosis. In addition to osmotically restoring this liquid layer, hypertonic saline improves the rheological properties of the mucus and stimulates cough. The net result is accelerated mucus clearance that is short-lived for single doses but sustained with regular inhalation. Long-term use improves lung function mildly but has marked benefits with respect to exacerbations, quality of life and absenteeism, without promoting infection or inflammation.
Summary: Hypertonic saline appears broadly applicable as an inexpensive therapy for most patients with cystic fibrosis.