TY - JOUR T1 - Acute and durable effect of inhaled hypertonic saline on mucociliary clearance in adult asthma JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00062-2021 SP - 00062-2021 AU - William D. Bennett AU - Allison Burbank AU - Martha Almond AU - Jihong Wu AU - Agathe Ceppe AU - Michelle Hernandez AU - Richard C. Boucher AU - David B. Peden Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/early/2021/04/08/23120541.00062-2021.abstract N2 - Background Impaired mucus clearance and airway mucus plugging have been shown to occur in moderate to severe asthma, especially during acute exacerbations. In cystic fibrosis (CF), where airway mucus is dehydrated, it has been shown that inhaled hypertonic saline (HS) produces both acute and sustained enhancement of mucociliary clearance (MCC). The current study was designed to assess the acute and sustained effect of inhaled 7%HS on MCC in adult asthma.Methods Well-controlled, moderate-severe female asthmatics (n=8) were screened with a single test dose of albuterol (4 puffs by metered dose inhaler) followed by HS (7% NaCl, 4 mL nebulised by Pari LC Star). Spirometry was measured at pre-treatment and 5- and 30-min post-treatment for safety. MCC was measured by gamma scintigraphy on three separate visits: at baseline, during inhalation of, and 4-h after a single dose of HS.Results MCC was acutely enhanced during HS treatment, mean clearance over 60 min of dynamic imaging Ave60Clr=8.9±7.9% (baseline) versus 23.4±7.6% (acute HS) (p<0.005). This enhancement was not maintained however over a 4-h period where post HS treatment Ave60Clr=9.3±8.2%. In this small cohort we found no decrements in lung function up to 30-min post treatment (FEV1% pred=97.4±10.0 and 98.9±10.7 pre-treatment versus 30-min post-treatment, respectively).Conclusion While MCC was rapidly enhanced during 7%HS treatment there was no effect on MCC at 4-h post treatment. While these findings may not support aerosolised HS use for maintenance therapy they do suggest a benefit for treating acute exacerbations in moderate-severe asthmatics.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Bennett reports grants from NIH, during the conduct of the study.Conflict of interest: Dr. Burbank reports grants from NIH, during the conduct of the study.Conflict of interest: Mrs. Almond reports grants from NIH, during the conduct of the study.Conflict of interest: Dr. Wu reports grants from NIH, during the conduct of the study.Conflict of interest: Ms. Ceppe reports grants from NIH, during the conduct of the study.Conflict of interest: M. Hernandez reports grants from NHLBI during the conduct of the study and personal fees for consultation on asthma therapies from GSK outside the submitted work.Conflict of interest: R.C. Boucher reports grants from the NIH; and personal fees from Parion Sciences, a privately held UNC spin-out company focused on developing therapies for CF, both during the conduct of the study. He is Chairman of the Board of Parion, and has equity in it and receives monetary compensation as Board Chair.Conflict of interest: Dr. Peden reports grants from NIH, during the conduct of the study; grants from US Environmental Protection Agency, outside the submitted work. ER -