<b>Why Hypertonic Saline Treatments (should) Work</b>
Some of the best discoveries happen quite by accident--telephones, silly putty and popsicles, just to name a few. The newest breakthrough in treatments for managing CF was also an incidental discovery. Someone noticed that people with CF who happened to be surfers exhibited fewer lung exacerbations than expected. This led to further investigation, and formal research of the benefits of salt water.
Although prevailing research for the use of hypertonic saline took place approximately 5 or more years ago, the use of hypertonic saline inhalation treatments for mucus clearance is the latest buzz in the CF world. My sincere appreciation goes out to those of you (and you know who you are) who were willing and able to participate in the clinical trials for this latest advance. In my opinion, every little bit helps when it comes to research, especially when the studies result in a worthwhile treatment option.
For those out there who may be starting on a regimen of nebulized hypertonic saline, or those who have been on it for awhile and can't seem to tell if it's making a difference or not, I'd like to explain in plain English the science behind the solution (pun intended).
First, let's get some background on those fancy scientific words.
Hypertonic saline solution: this means that the ratio of salt to water in the solution is less than the ratio of salt to water in the cells of the body. The body prefers that its cells are in an isotonic state, meaning that the ratios of salt to water inside the cell are equal to the amounts in the rest of the body's cells.
Here's a practical example of how to create an isotonic environment. Suppose you're at a picnic and there are two groups of people, each sitting on their own picnic blanket. On one blanket there are 4 guys, and on the other are 3 gals. The gals have 4 sandwiches among them. The guys have 3 sandwiches among them. You'll notice that the number of sandwiches and the number of people are the same, but the sandwiches are not evenly distributed among the individuals on each picnic blanket. It would make sense that the gals would share their 4th sandwich with the guy on the other blanket. This results in an isotonic situtation--the ratio of sandwiches to people is the same for each group on their individual picnic blankets.
Now, let's apply this back to CF.
In people with CF, our lungs are pretty dried out, which is related to the fact that we secrete so much salt when we sweat, and that salt pulls with it a lot of the water molecules we need. Without that water in our cells, it is very hard to effectively cough up the thick mucus we produce. There's so much gunk in there that needs to come out, but the body chemistry isn't right to make that happen easily. It's about as effective as trying to go the distance on a slip-n-slide before you turn on the water.
The amount of salt (concentration) in a hypertonic saline solution is less than the amount of salt in the cells lining our lungs. (This is why it is imperative that the proper concentration (i.e. 7%) be used in the nebulizer). Think of the amount of water in the solution as the sandwich from our picnic example. Inhaling the hypertonic saline is the same as donating a sandwich to the guys on the other picnic blanket. Similarly, the body pulls the water out of the inhaled solution and applies it to our cells. This of course, makes things more moist in there, which is good. The increased moisture in the cells lining our lungs makes it much easier to cough productively.
On a personal note, I feel like I am doing well with the hypertonic saline treatments. They are making me cough more, which is slightly annoying, but I know that coughing is a good thing. The more gunk I'm able to cough up, the less there is remaining in there to harbor a nasty infection. Hypertonic saline treatment might not make you "feel" better per se, like a bronchodilater will. That's because the treatment is more like a chemical form of chest PT, and not like taking a round of antibiotics. Slow and steady wins the race with this one.
Don't expect to feel a dramatic difference after a saline treatment; instead, be diligent with your treatments knowing that it is preventive in nature and will likely reduce the number of infections that you'll get later on. Yes, it can be cumbersome and annoying to have even more treatments to add to the daily regime, but 20-30 minutes spent following your treatment plan have potentially significant payoffs when it comes to quality of life.
I'm not a doctor, nor do I play one on TV, but I know science. I hope this explanation has been helpful. As with anything regarding your own treatments, please check with your doctor if you need more information.
<a target=_blank class=ftalternatingbarlinklarge href="http://livingwellwithcf.blogspot.com/2006_03_01_livingwellwithcf_archive.html">Originally posted on Breathing Deeply: My Life with Cystic Fibrosis</a>
-lightNlife
Some of the best discoveries happen quite by accident--telephones, silly putty and popsicles, just to name a few. The newest breakthrough in treatments for managing CF was also an incidental discovery. Someone noticed that people with CF who happened to be surfers exhibited fewer lung exacerbations than expected. This led to further investigation, and formal research of the benefits of salt water.
Although prevailing research for the use of hypertonic saline took place approximately 5 or more years ago, the use of hypertonic saline inhalation treatments for mucus clearance is the latest buzz in the CF world. My sincere appreciation goes out to those of you (and you know who you are) who were willing and able to participate in the clinical trials for this latest advance. In my opinion, every little bit helps when it comes to research, especially when the studies result in a worthwhile treatment option.
For those out there who may be starting on a regimen of nebulized hypertonic saline, or those who have been on it for awhile and can't seem to tell if it's making a difference or not, I'd like to explain in plain English the science behind the solution (pun intended).
First, let's get some background on those fancy scientific words.
Hypertonic saline solution: this means that the ratio of salt to water in the solution is less than the ratio of salt to water in the cells of the body. The body prefers that its cells are in an isotonic state, meaning that the ratios of salt to water inside the cell are equal to the amounts in the rest of the body's cells.
Here's a practical example of how to create an isotonic environment. Suppose you're at a picnic and there are two groups of people, each sitting on their own picnic blanket. On one blanket there are 4 guys, and on the other are 3 gals. The gals have 4 sandwiches among them. The guys have 3 sandwiches among them. You'll notice that the number of sandwiches and the number of people are the same, but the sandwiches are not evenly distributed among the individuals on each picnic blanket. It would make sense that the gals would share their 4th sandwich with the guy on the other blanket. This results in an isotonic situtation--the ratio of sandwiches to people is the same for each group on their individual picnic blankets.
Now, let's apply this back to CF.
In people with CF, our lungs are pretty dried out, which is related to the fact that we secrete so much salt when we sweat, and that salt pulls with it a lot of the water molecules we need. Without that water in our cells, it is very hard to effectively cough up the thick mucus we produce. There's so much gunk in there that needs to come out, but the body chemistry isn't right to make that happen easily. It's about as effective as trying to go the distance on a slip-n-slide before you turn on the water.
The amount of salt (concentration) in a hypertonic saline solution is less than the amount of salt in the cells lining our lungs. (This is why it is imperative that the proper concentration (i.e. 7%) be used in the nebulizer). Think of the amount of water in the solution as the sandwich from our picnic example. Inhaling the hypertonic saline is the same as donating a sandwich to the guys on the other picnic blanket. Similarly, the body pulls the water out of the inhaled solution and applies it to our cells. This of course, makes things more moist in there, which is good. The increased moisture in the cells lining our lungs makes it much easier to cough productively.
On a personal note, I feel like I am doing well with the hypertonic saline treatments. They are making me cough more, which is slightly annoying, but I know that coughing is a good thing. The more gunk I'm able to cough up, the less there is remaining in there to harbor a nasty infection. Hypertonic saline treatment might not make you "feel" better per se, like a bronchodilater will. That's because the treatment is more like a chemical form of chest PT, and not like taking a round of antibiotics. Slow and steady wins the race with this one.
Don't expect to feel a dramatic difference after a saline treatment; instead, be diligent with your treatments knowing that it is preventive in nature and will likely reduce the number of infections that you'll get later on. Yes, it can be cumbersome and annoying to have even more treatments to add to the daily regime, but 20-30 minutes spent following your treatment plan have potentially significant payoffs when it comes to quality of life.
I'm not a doctor, nor do I play one on TV, but I know science. I hope this explanation has been helpful. As with anything regarding your own treatments, please check with your doctor if you need more information.
<a target=_blank class=ftalternatingbarlinklarge href="http://livingwellwithcf.blogspot.com/2006_03_01_livingwellwithcf_archive.html">Originally posted on Breathing Deeply: My Life with Cystic Fibrosis</a>
-lightNlife