Breathe easier with saltwater

Saline solution helps lessen symptoms of cystic fibrosis

Researchers in Chapel Hill and Australia have proved that low-cost, low-tech saltwater can protect the lungs of people fighting cystic fibrosis.

The treatment can't cure the lethal disease. But UNC-Chapel Hill scientists see potential to reduce suffering and extend lives. They say the earlier the treatment gets applied, the bigger the benefits may be.

"This is the first therapy that seems to interfere with the early steps of lung disease," said Dr. Scott Donaldson, a UNC-CH pulmonologist. "It raises the possibility that we may prevent or delay the progression of lung disease."

Cystic fibrosis afflicts about 30,000 Americans who are highly vulnerable to infections that, over time, badly damage their lungs. Most people with cystic fibrosis die by their mid-30s.

Most people have a thin coating of water covering their lung surfaces. But people with cystic fibrosis have sticky mucus that traps bacteria, viruses and other microscopic troublemakers. A genetic mutation prevents water from traveling to the surface of lung cells.

People with the disease work hard to stay healthy every day. Children put on mechanical vests to knock mucus off their lungs, or their parents pound their chests by hand.

Adults and kids take multiple drugs to expand their airways and fight infections. Frequently, they still end up in hospitals needing more intensive care. Some become so damaged they require lung transplants to survive.

But the new studies, published today in The New England Journal of Medicine, show that inhaling water twice as salty as seawater may slow the damage.

Researchers in Sydney, Australia, gave the saline to 164 patients for almost a year. Patients taking concentrated saline, a 7 percent salt solution, experienced fewer lung problems than those inhaling normal saline. Patients needed fewer antibiotics to treat infections, attended school more regularly and participated in more activities.

The UNC study enrolled smaller numbers of people but also logged promising results. Just as important, the study provides more evidence that cystic fibrosis patients have the means to clear their lungs more normally when their lungs get moist enough, said Dr. Richard C. Boucher Jr., director of UNC's Cystic Fibrosis Research & Treatment Center.

The salt remains on patients' lungs long enough to draw water to the surface and keep it there.

The results are convincing enough that after Thomas Murphy, a Duke pulmonologist, reviewed them he said he intends to start giving his Durham patients saline, though probably not four times a day as occurred during the studies.

"It's a real therapy that is not a real expensive therapy," he said. "This will help a lot."

Donaldson, the UNC doctor, said he expects giving saline to children could do the most good. That could delay the cycle of infection and lung damage that so many cystic fibrosis patients live with.

UNC has started tests in children, first to make sure the salt water doses are safe. It is seeking funding to do studies in infants, Donaldson said.

But breathing saltwater is already standard for adults treated at UNC. Louisa Chrisco, an N.C. State University junior, is among the patients who load her nebulizer, a drug delivery pump, with saline twice a day.

Morning and night, she sits at her desk in her Bragaw Hall dorm room, which is covered with snapshots of smiling friends. For half an hour she inhales saline and a drug that is a bronchial dilator. It makes her cough, hard.

But the Kinston native, who wants to be a hospital nutritionist one day, is happy to do it.

"I'll do anything to make my life easier and keep my lung function where it is," Chrisco said. "I'm willing to try anything."