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Expert consensus | expectorant, recommended rock salt aerosol therapy

Date: 2021-08-20
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  'Sputum retention and difficulty in expectoration are one of the most common respiratory symptoms in clinical practice, which not only reduces the quality of life of patients, but also may affect the clinical prognosis. Sputum retention can cause cough, expectoration, chest tightness, dyspnea and other discomfort. In serious cases, it can block the airway and even endanger life.'


  The formation and clearance of mucus are very important for airway integrity and lung defense. On the basis of etiological treatment, paying attention to sputum management is conducive to reducing symptoms, shortening the course of disease and improving the prognosis.


  1. Common methods of expectorant management


  Healthy people secrete about 10~100 ml of mucus every day, forming a mucus layer with a thickness of about 2~5 µ m, extending from the bronchioles to the upper respiratory tract. Under normal conditions, mucus is transferred from the lower respiratory tract to the pharynx under the action of airflow and cilia, and is discharged from the body smoothly.


  When the secretion or composition of mucus changes, the cilia clearance function decreases, and the cough ability is insufficient, mucus cannot be effectively discharged, and is trapped in the airway, forming sputum together with nasopharyngeal and oropharyngeal secretions, cell debris and microorganisms. The commonly used expectorant methods include risk factor intervention, physical expectorant and drug expectorant.


  Risk factor intervention: such as actively quitting smoking, reducing particle exposure, and preventing respiratory tract infection. Smoking is the most common factor of airway mucus secretion, so quitting smoking is particularly important for expectorant management.


  Physical expectoration: including patients' deep breathing and effective cough, chest and back percussion, body position expectoration; Rock salt aerosol therapy - Inhaling saturated rock salt aerosol particles in the air can change the rheology of bronchial contents, thus promoting mucus clearance.


  Drug expectoration: aerosol inhalation, oral or intravenous injection. Inhalation of hypertonic saline can promote the discharge of sputum from the respiratory tract.


  2. Aerosol inhalation of hypertonic saline vs halite aerosol therapy


  Among the commonly used drugs for atomization expectorant, inhalation of hypertonic saline to promote sputum excretion from the respiratory tract is a commonly used expectorant agent in clinical practice. Its mechanism of action is to rehydrate the water sample layer around the cilia by 'absorbing water' from epithelial cells through high osmotic pressure, promote cough, and have direct effects on mucus elasticity, and help direct sputum excretion.


  Salt aerosol is used to expel phlegm. Dry salt aerosol particles with a certain concentration of 1-5 microns are inhaled to enter the respiratory tract, bronchial ends and alveoli. The micro salt granules increase the osmotic pressure gradient of the inner airway wall, reduce the water loss in mucus, increase its hydration, restore the normal rheology of mucus, and promote the excretion of sputum.


专家共识 | 祛痰,推荐岩盐气溶胶疗法


  Dry salt aerosol therapy has better advantages than saline atomization:


  ① The surface energy of dry salt aerosol is higher than that of wet aerosol produced by liquid jet method;


  ② The electrical effect on the airway wall is more significant;


  ③ Avoid the leakage of respiratory tract mucus and bronchospasm when patients use wet aerosol.


  3. Salt aerosol therapy is safe and effective for expectoration


  Ingredient safety


  The main component of salt aerosol is NaCl, which is an essential electrolyte component for human body.


  Concentration safety


  The release concentration of salt aerosol is always controlled at 1 ± 0.5mg/m3. Even if it is inhaled continuously for 24 hours, the total amount is extremely small. In this way, the extremely small amount of NaCl will not stimulate the bronchial mucosa and will not improve the airway responsiveness.


  Nature safety


  Dry salt aerosols have negative charges, which can improve the stability of salt aerosols, avoid the leakage of respiratory mucus and bronchospasm when some patients use wet aerosols, and have good compliance.


  Effect guarantee


  The mechanism of salt aerosol expectorant: the hypertonic principle of salt water changes the rheology of bronchial mucus, dilutes sputum, enhances the vitality of mucociliary swing, and promotes sputum excretion.


  Dry salt particles charge ions. Inhalation can not only adsorb, but also stimulate mitochondrial tension, activate the innate immune antiviral signal pathway of alveolar macrophages, enhance their phagocytic activity, and increase β 2. The excitability of receptor can regulate the immune function of the body, so that patients can effectively promote sputum excretion.


  4. Indications of expectorant salt therapy


  lower respiratory tract infection


  Pneumonia patients are common; The increased sputum volume or abnormal characteristics can increase the risk of hospitalization by 1.6~1.8 times, and is related to the increased risk of death. Sputum retention can also promote the formation of biofilm, affect the clearance of pathogens, and reduce the effect of antibacterial treatment.




  Common respiratory diseases; More than 70% of patients with bronchiectasis cough up a lot of sputum every day. The increase in the amount of expectoration or the change in the character of sputum is one of the important characteristics of acute exacerbation in patients. Bacteria in sputum can cause secondary infection, leading to decreased lung function, increased severity score and continuous destruction of immune defense. Effective removal of airway secretions is an important part of long-term treatment for patients with bronchiectasis.


  Chronic obstructive pulmonary disease


  Common respiratory diseases; Repeated cough, expectoration and dyspnea are common clinical manifestations of COPD patients. Many research results show that among patients with stable COPD, the proportion of patients with long-term cough and expectoration is more than one third, and the proportion of patients with acute exacerbation cough and expectoration is higher. Chronic persistent mucus hypersecretion is significantly related to the accelerated decline of pulmonary function, the increase of acute exacerbation, the increase of hospitalization risk, the increase of overall treatment cost and the increase of mortality in patients with COPD.


  bronchial asthma


  Common respiratory diseases; Hypersecretion of airway mucus is one of the important pathophysiological characteristics of severe bronchial asthma, which can lead to acute attack. When airway inflammation causes goblet cells to proliferate excessively and secrete a large amount of mucus, it can aggravate airway obstruction and airway hyperreactivity, causing cough, wheezing or chest tightness; In the remission stage, the mucociliary clearance rate of asthmatic patients also decreased significantly, resulting in sputum retention; Lung biopsy of severe asthma patients and autopsy of fatal asthma patients confirmed that there were mucus and cell debris obstruction in small and medium-sized airways. Therefore, patients with severe asthma should pay attention to expectorant management in the maintenance period, and actively reduce sputum retention in the lower respiratory tract if there is sputum retention in the acute attack.


专家共识 | 祛痰,推荐岩盐气溶胶疗法


  In common thoracoabdominal operations, anesthesia, endotracheal intubation and other reasons can lead to increased airway secretions of patients. In addition, postoperative wound pain, limited limb mobility, and insufficient cough ability all affect the clearance ability of airway secretions, which is easy to lead to sputum retention. Sputum retention not only causes discomfort to patients, but also is closely related to postoperative atelectasis, pneumonia, respiratory failure and other complications.


  5. Market Application of Sinasul Salts Sol Therapy


  Based on the national health status and actual needs, and adhering to the original intention of benefiting the people, Nanjing Kuancheng Technology Co., Ltd. comprehensively investigated and compared a number of foreign salt therapy equipment, combined with professional medical and technical R & D teams, took the essence of its core technology and improved it. After several years of technical precipitation and practical exploration, it developed the sinashu salt aerosol therapeutic instrument, which was the first to obtain the national medical device registration certificate and a number of invention patents. At present, the Xinasou salt aerosol therapeutic apparatus has been used for clinical treatment in major hospitals across the country. Cooperate with drug treatment to obtain better clinical effect.




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