As the pharmacist at an adult cystic fibrosis center for the past 10 years, I often have heard the frustrations that patients have regarding the time it takes to do their inhaled therapies. I really can't imagine. I have asthma, requiring me to take one inhaler twice daily, and I struggle to remember to do that consistently (I know … health care providers are the worst). I have such profound respect for my patients -- for you.
What I have learned over the past 10 years is that the quick tips I pass from patient to patient seem to be the most helpful. They may include anything from the way a patient manages adverse effects to cost-saving measures. So please, don't be shy with your care team about what is working for you -- or what isn't!
One of the goals I have as part of the care team is to help patients understand why we may add an additional medication when they are already juggling their current therapies with their day-to-day lives. Many of my patients let hypertonic saline fall through the cracks. With the main side effect being coughing (which isn't necessarily a bad thing), and the additional time it takes to nebulize, many of my patients skip this therapy. Why is it so important, then?
Hypertonic saline has been shown to improve lung function, decrease exacerbations and improve quality of life. Adding hypertonic saline can be a great option for my patients who are already taking dornase alfa (Pulmozyme®) and an inhaled antibiotic, but need to step up therapy because of increased symptoms or decreased FEV1. It is also an option for patients who have trouble bringing up sputum. This is where the side effect of coughing can be an advantage (as long as it is not serious). But for some people, the benefit they see from hypertonic saline doesn't seem to be worth the pressure of working another medication into their routine or the side effects they experience. That's where your care team can help.
Many medications involve balancing their therapeutic effects with their side effects. That's why it's important to tell your care team when side effects get worse or decrease your quality of life. For example, if you find that you cough too much or have increased shortness of breath, you have a couple of options. You can use an albuterol inhaler first, or you can decrease your hypertonic saline from 7% to 3%. This lower concentration may ease the irritation.
One of the few times we recommend calling your doctor, and waiting to take hypertonic saline, is if you are coughing up blood. Hypertonic saline can irritate the airways and make the bleeding worse.
If cost is an issue, some specialty pharmacies provide hypertonic saline for free if you order dornase alfa and inhaled antibiotics from them. The Cystic Fibrosis Foundation's patient assistance program, Compass, can also be a great resource.
We don't mean for hypertonic saline to be a burden, but rather an addition to your current arsenal of therapies. If you have any questions about adverse effects or how to better fit hypertonic saline into your schedule, talk to you pharmacist or respiratory therapist about ideas.
