DuPont Challenge Science Essay Competition

Salt: Enhancing Lives One Breath at a Time

by Jayme Warner

InTech Collegiate High School
North Logan, Utah
Sponsoring Teacher: Stephanie Kawamura

First place, senior division, 2011

I lay in bed listening to my 7-year-old sister Katie cough and struggle to breathe; I knew another long night lay ahead for her and for my mother. My sister gasped for air and attempted to get another breath and soon my mother appeared, pounded on my sisters back, and held her while she coughed and gagged. My sister cried and eventually fell asleep while my mother watched over her. The nightly ritual had just begun. I knew that in the morning, my sister would awake tired and lethargic, and my mother would pound on her back while my sister coughed and gagged. Before breakfast, my little sister would be expected to take a number of pills so that her food would remain in her stomach. My sister would then go to school, trying to face the challenges of a seven-year-old, while struggling to breathe and function. My little sister, like thousands of other people across the country, lives with Cystic
Fibrosis (CF). Cystic Fibrosis is described as a defective gene and its protein product [which] cause the body to produce unusually thick, sticky mucus that clogs the lungsobstructs the pancreas and stops natural enzymes from helping the body break down and absorb food. (CFF, 2010)

Those affected with Cystic Fibrosis have lives filled with mucus thinners, antibiotics, nebulizers, inhalers and breathing treatments; the daily treatments are both time-consuming and expensive. What if a treatment could be found that is both inexpensive and lessens the time needed for the other necessary daily therapies? I believe that this type of treatment could greatly enhance the daily life of one afflicted by Cystic Fibrosis as well as the entire family! Fortunately, a new treatment is surfacing, one that is giving hope to those affected with Cystic Fibrosis: Hypertonic Saline Therapy. What is Hypertonic Saline Therapy and how does it help those affected by Cystic Fibrosis?

Scientifically, the airway surface liquid is kept at the height of the cilia that lines the bronchial airways leading to the lungs. The cilia are responsible to keep the lungs free of debris and infection. Those with Cystic Fibrosis suffer from a dysfunction of the cystic fibrosis transmembrane conductance regulator protein which results in failure of chloride movement across the airways and excess movement of sodium into the cells. Water passively follows the movement of sodium, reducing the volume of the ASL. This is one reason for the excess viscosity (stickiness) of the airway mucus and the failure of the lungs self-cleansing mechanism, the mucociliary clearance, to work effectively. The retained, viscous mucus is a focus for infection. (Elkins & Bye, 2006)

In essence, those with Cystic Fibrosis struggle to breathe, suffer with lung infections and coughing spasms and have difficulty eating. In the past, children born with Cystic Fibrosis rarely aged enough to make it to kindergarten; today, however, with significant research and amazing advances in medicine, those affected with Cystic Fibrosis can now live for several decades.

Although Hypertonic Saline Therapy is an additional form of treatment for a CF patient, it is one that appears promising to assist CF patients improve the quality of their daily lives. After researchers in Australia noted that surfers with Cystic Fibrosis suffered less lung infections and less breathing problems compared to CF patients who didnt surf, the effects of salty air were studied. The researchers found that treatment with hypertonic saline at 7% inhaled twice per day reduces episodes of chest infection and is linked to improved lung function, improved quality of life, and better attendance at school or work. (Wark, 2009)

Hypertonic saline is a salt and water solution that contains more salt than what is found in our bodies. For instance, a normal saline solution is 0.9% salt whereas the hypertonic saline used for Cystic Fibrosis patients is 7.0% salt. How does this promising treatment work? Osmosis is described as the diffusion of water through a semipermeable membrane from an area of higher concentration of water to an area of lower concentration of water and hypertonic is defined as the greater solute concentration when comparing two solutions. (Campbell, 2005)

In the process of osmosis, salt leads the way in the saline solution and draws fluid back into the airway, thus accelerating mucus clearance. (Robinson et al, 1997) Cystic Fibrosis patients can breathe a hypertonic saline solution of 7% salt through a nebulizer and the inhaled salty air goes into the airway, draws water from cells and into the airway, thinning the thick mucus in the process and thus, making it easier to cough up the mucus. In essence, hypertonic saline allows easier breathing for those affected by Cystic Fibrosis.

Over the past few years, several studies regarding Cystic Fibrosis and Hypertonic Saline Therapy have been conducted; all have had the same results: Hypertonic Saline Therapy is an inexpensive yet effective treatment for patients. Through the use of Hypertonic Saline Therapy, patients had an increase in mucus clearance along with improved lung protection; this led to overall protection of the lungs and increased health and quality of life.

Today, research continues on implementing Hypertonic Saline Therapy in the daily treatment of Cystic Fibrosis patients; children as young as five years old are starting to feel better because of this treatment. This solution is helping CF patients across the world have a higher quality of life and breathe a little easier. Tonight when I go to bed, I won't hear my sister gagging and coughing and I wont hear her crying and struggling to sleep. Tomorrow when she wakes, Katie will be energetic and happy instead of tired and cranky. Because of Hypertonic Saline Therapy, mixed with her other treatments, my little sister can now enjoy school, she can swing and run at recess, concentrate on homework and sing in our local community choir. Like thousands of CF patients undergoing Hypertonic Saline Therapy, Katie can finally enjoy life like any other 7-year-old child.

Sources

• About Cystic Fibrosis. Cystic Fibrosis Foundation. n.d. Retrieved from: www.cff.org/AboutCF
• Campbell, N.A. and Reece, J.B. Biology . 7th edition ed. San Francisco: Pearson, 2005.
• Donaldson, S.H., Bennett, W.D., Zeman, K.L., et al. Mucus Clearance and Lung Function in Cystic Fibrosis with Hypertonic Saline. New England Journal of Medicine. 354(3) (4 August 2008): 1848-1851.
• Elkins, M.R., Robinson, R., Rose, B.R., et al. Controlled Trial of Long Term Inhaled Hypertonic Saline in Patients with Cystic Fibrosis. New England Journal of Medicine. 354(3) (26 January 2006): 229-240.
• Elkins, M.R. and Bye, P.T. Inhaled Hypertonic Saline as a Therapy for Cystic Fibrosis. Current Opinion in Pulmonary Medicine. 12. (2006): 445-452.
• Enderby, B. and Doull, I. Hypertonic Saline Inhalation in Cystic Fibrosis Salt in the Wound, or Sweet Success? Archives of Diseases in Childhood. 92. (2007): 195-196. doi:10.1136/adc.2006.094979
• Hubbard-Jorgensen, Dr. Nina. Personal Interview. December 22, 2010.
• Levin, M.H., Sullivan, S., Nielson, D., Yang, B. Hypertonic Saline Therapy in Cystic Fibrosis: Evidence Against the Proposed Mechanism Involving Aquaporins. Journal of Biological Chemistry. 281 (7 July 2006): 25803-25812. doi: 10.1074/jbc.M604332200
• Taylor, L.M., and Kuhn, R.J. Hypertonic Saline Treatment of Cystic Fibrosis. The Annals of Pharmacotherapy. 41(3). (2007): 481-474. doi 10.1345/aph.1H425
• Warner, Katelyn Michelle. Personal Interview. December 15, 2010.
• Williams H.D., Behrends V., Bundy J.G., Ryall B. and Zlosnik J. Hypertonic Saline Therapy in Cystic Fibrosis: Do Population Shifts Caused by the Osmotic Sensitivity of Infecting Bacteria Explain the Effectiveness of this Treatment? Microbio. 1 (2010): 120. doi:10.3389/fmicb.2010.00120