Rationale: The utilization of nebulized Hypertonic Saline (HS) is a common practice in patients with bronchiectasis to facilitate mucociliary clearance. Despite its recommendation in international guidelines, limited data exist to substantiate the use of HS. To address this gap, this study focused on providing a comprehensive description of the bronchiectasis patient population who receive HS, drawing upon data obtained from the United States Bronchiectasis and NTM Research Registry.

Methods: This study utilized baseline data from the United States Bronchiectasis and NTM Research Registry, which is sponsored by the COPD Foundation. The analysis included patients who had a confirmed diagnosis of bronchiectasis. Patients with cystic fibrosis and those who used bronchial hygiene measures other than Hypertonic Saline (HS) or Positive Expiratory Pressure (PEP) were excluded from the analysis. The eligible patients were categorized into four distinct groups: HS only, PEP only, HS & PEP, or no airway clearance or mucoactive agent. Descriptive statistics were calculated for the overall study population and were further stratified by the four groups. To assess differences in continuous variables, one-way ANOVA was performed, while chi-square tests were used to analyze associations between categorical variables across the four groups.

Results: A total of 1970 patients were included in the analysis (Table). The overall cohort had a mean age of 67.1 +12.4 years, with the majority being Caucasian (89%), and female (80%). The use of Positive Expiratory Pressure (PEP) and/or Hypertonic Saline (HS) was significantly associated with several factors, including experiencing a productive cough (p < 0.0052), a bronchiectasis exacerbation in the two years prior to enrollment (p < 0.001), the presence of Non-Tuberculous Mycobacteria (NTM) (p = 0.042), and positive cultures for Pseudomonas aeruginosa (p < 0.001) (Table). Among patients who had experienced a productive cough in the previous two years (n = 887), approximately half of them (423/887, 48%) used HS and/or PEP. Of those, 38% used HS alone, 22% used PEP alone, and 40% used both PEP and HS. Similarly, around half of the patients with Pseudomonas aeruginosa (157/329, 48%) used HS and/or PEP, with 48% using HS alone, 13% using PEP only, and 39% using both modalities.

Conclusion: In patients with bronchiectasis, the utilization of nebulized hypertonic saline is frequently observed in individuals with a productive cough as well as in those with Pseudomonas aeruginosa. However, additional longitudinal analysis is warranted to further explore and compare the differences between these patient groups.

American Thoracic Society (ATS) 2023 International Conference, 19th May - 24th May 2023, Washington DC.