Outcomes of hypertonic saline inhalation as a treatment modality in nontuberculous mycobacterial pulmonary disease

Treatment of nontuberculous mycobacterial pulmonary disease (NTM-PD) poses a challenge for clinicians and patients. Treatment involves 18–24 months of multi-drug antibiotic therapy and has a cure rate of 50–70% [1]. Cure rates depend on the causative NTM species, drug susceptibility and disease manifestation; macrolide-resistance and fibro-cavitary disease are risk factors for treatment failure. Even when treatment is considered successful, there is a high risk of recurrence, either by relapse or re-infection. Furthermore, adverse events, like gastrointestinal discomforts are frequently seen and occasionally necessitate treatment discontinuation [1]. Management of underlying pulmonary diseases is essential for successful NTM-PD treatment [1]. Since hypertonic saline (HS) inhalation is safe and has shown a clinical effect in bronchiectasis patients [2–4] we have included HS inhalation in our local NTM treatment protocol. In clinical practice, we advise patients with nodular-bronchiectatic disease to start with HS inhalation two times daily as the only therapy for the first 3 months. When patients tolerate HS and when there are no clinical signs of disease deterioration, we continue HS as the only treatment with close observation of possible disease progression. This clinical observation includes a high resolution chest tomography (HRCT), sputum or broncho-alveolar lavage (BAL) mycobacterial cultures and pulmonary function tests. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . 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 ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr. Huiberts has nothing to disclose. Conflict of interest: Dr. Zweijpfenning has nothing to disclose. Conflict of interest: Dr. Pennings has nothing to disclose. Conflict of interest: Dr. Boeree has nothing to disclose. Conflict of interest: Dr. van Ingen has nothing to disclose. Conflict of interest: Dr. Magis-Escurra has nothing to disclose. Conflict of interest: Dr. Hoefsloot has nothing to disclose.