Hypertonic Saline Inhalation for Nontuberculous Mycobacterial Lung Disease (HiNTM)
A Randomized Controlled Trial of Early Versus Delayed Hypertonic Saline Inhalation in Treatment-Naïve Nontuberculous Mycobacterial Lung Disease
This multicenter randomized controlled trial evaluates the clinical and microbiological effects of inhaled 3% hypertonic saline in treatment-naïve patients with nontuberculous mycobacterial lung disease (NTM-LD). Participants are randomized in a 1:1 ratio to either early initiation of 3% hypertonic saline for 6 months or delayed initiation consisting of normal saline inhalation during the first 3 months followed by 3% hypertonic saline during the subsequent 3 months.
The primary objective is to compare respiratory symptom improvement between hypertonic saline and normal saline at Month 3. Secondary objectives include evaluating sputum microbiological outcomes, radiographic changes, inflammatory markers, small airway function, treatment initiation, safety, and within-participant changes before and after switching from normal saline to hypertonic saline in the delayed-initiation arm.
The first participant was enrolled on October 3, 2025.
調査の概要
詳細な説明
Nontuberculous mycobacterial lung disease (NTM-LD) is a chronic pulmonary infection that frequently progresses despite conservative management. Because prolonged multidrug antibiotic therapy is associated with substantial treatment burden, potential toxicity, and variable effectiveness, additional non-antibiotic treatment strategies are needed, particularly for patients who defer, cannot tolerate, or are not yet indicated for antibiotic treatment.
Hypertonic saline inhalation facilitates airway clearance and sputum removal and has been increasingly used as an adjunctive treatment in specialized NTM centers. However, prospective randomized data remain limited, particularly in Asian populations.
This multicenter randomized controlled trial investigates whether early initiation of inhaled 3% hypertonic saline improves respiratory symptoms and microbiological outcomes compared with delayed initiation.
To ensure treatment safety, all participants undergo a supervised inhalation tolerance assessment before randomization. During this assessment, inhaled salbutamol (Ventolin) premedication is administered, followed by inhalation of 3% hypertonic saline. Participants demonstrating clinically significant intolerance, severe bronchospasm, or other safety concerns are excluded from study treatment.
Following successful completion of the tolerance assessment, participants are randomized to one of two groups.
The early-initiation group receives inhaled 3% hypertonic saline for 6 months. The delayed-initiation group receives inhaled normal saline during Months 0-3, followed by inhaled 3% hypertonic saline during Months 4-6.
The primary randomized comparison is performed at Month 3 between participants receiving hypertonic saline and those receiving normal saline. Additional analyses evaluate within-participant changes in the delayed-initiation arm before and after switching from normal saline to hypertonic saline.
Throughout the study, participants continue routine clinical care. Initiation of anti-NTM antibiotic treatment remains at the discretion of the treating physician.
研究の種類
入学 (推定)
段階
- 適用できない
連絡先と場所
研究連絡先
- 名前：Sheng-Wei Pan, MD, PhD
- 電話番号：+886-2-28717456
- メール：swpan2@vghtpe.gov.tw
研究連絡先のバックアップ
- 名前：Jia-Yih Feng, MD, PhD
- 電話番号：+886-2-28712121
- メール：jyfeng@vghtpe.gov.tw
研究場所
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Taipei、台湾、11217
- 募集
- Taipei Veterans General Hospital
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コンタクト：
- Sheng-Wei Pan, MD, PhD
- 電話番号：+886-2-28757456
- メール：swpan2@vghtpe.gov.tw
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-
参加基準
適格基準
就学可能な年齢
- 大人
- 高齢者
健康ボランティアの受け入れ
説明
Inclusion Criteria:
- Adults aged 18 years or older.
- Diagnosis of nontuberculous mycobacterial lung disease (NTM-LD) according to ATS/ERS/ESCMID/IDSA diagnostic criteria, including compatible clinical symptoms, radiographic findings, and microbiological evidence.
- Not receiving anti-NTM antibiotic treatment at the time of screening.
- Able and willing to provide written informed consent.
- Able to perform nebulized inhalation therapy using a mesh nebulizer at home.
Exclusion Criteria:
- Active tuberculosis.
- Human immunodeficiency virus (HIV) infection.
- Receiving active treatment for malignancy.
- Uncontrolled asthma.
- Frequent or clinically significant hemoptysis.
- History of intolerance, bronchospasm, or hypersensitivity during inhalation testing with hypertonic saline.
- Inability to prepare a mesh nebulizer or perform inhalation therapy at home.
- Any condition that, in the opinion of the investigator, would make participation unsafe or interfere with study participation.
研究計画
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：処理
- 割り当て：ランダム化
- 介入モデル：並列代入
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
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実験的：Early Hypertonic Saline Initiation
Participants receive nebulized 3% hypertonic saline (5 mL once daily via mesh nebulizer) for 6 months in addition to standard clinical care.
Anti-NTM antibiotic treatment may be initiated at the discretion of the treating physician according to clinical indications.
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Nebulized 3% hypertonic saline, 5 mL once daily via mesh nebulizer.
Administered during Months 0-6 in the early-initiation arm and during Months 4-6 in the delayed-initiation arm after completion of the Month 3 assessment.
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アクティブコンパレータ：Delayed Hypertonic Saline Initiation
Participants receive nebulized normal saline (5 mL once daily via mesh nebulizer) during Months 0-3, followed by nebulized 3% hypertonic saline during Months 4-6, in addition to standard clinical care.
Anti-NTM antibiotic treatment may be initiated at the discretion of the treating physician according to clinical indications.
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Nebulized 3% hypertonic saline, 5 mL once daily via mesh nebulizer.
Administered during Months 0-6 in the early-initiation arm and during Months 4-6 in the delayed-initiation arm after completion of the Month 3 assessment.
Nebulized 0.9% normal saline, 5 mL once daily via mesh nebulizer during Months 0-3 in the delayed-initiation arm.
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Change in Total Respiratory Severity Score (RSS) From Baseline to Month 3
時間枠：Baseline and Month 3
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Total Respiratory Severity Score (RSS) ranges from 0 to 60 and is calculated from six visual analog scales evaluating cough, sputum production, dyspnea, fatigue, sleep disturbance, and overall respiratory symptoms.
Higher scores indicate worse symptoms.
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Baseline and Month 3
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Change in Acid-Fast Bacilli (AFB) Sputum Smear Grade Over Time
時間枠：Baseline, Month 3, and Month 6
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AFB sputum smear grade assessed using standard semi-quantitative microscopy (negative, scanty, 1+, 2+, 3+, or 4+) at Baseline, Month 3, and Month 6. Changes in smear grade and the proportion of participants achieving smear negativity will be evaluated.
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Baseline, Month 3, and Month 6
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Change in Mycobacterial Sputum Culture Status Over Time
時間枠：Baseline, Month 3, and Month 6
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Sputum culture status assessed as positive or negative for nontuberculous mycobacteria using standard mycobacterial culture methods at Baseline, Month 3, and Month 6. Culture conversion is defined as a change from positive at baseline to negative at follow-up assessments.
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Baseline, Month 3, and Month 6
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Change in Radiographic Severity Score From Baseline to Month 6
時間枠：Baseline and Month 6
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Radiographic Severity Score assessed using a chest radiographic scoring system.
Each lung is divided into three areas.
The extent of infiltration in each area is scored from 0 to 3, resulting in a total score ranging from 0 to 18. Higher scores indicate more extensive pulmonary disease.
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Baseline and Month 6
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Change in Erythrocyte Sedimentation Rate (ESR) From Baseline to Month 6
時間枠：Baseline and Month 6
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Erythrocyte sedimentation rate (ESR) will be measured using a standard clinical laboratory assay.
Higher values indicate greater systemic inflammation.
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Baseline and Month 6
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Change in R5-R20 Measured by Impulse Oscillometry From Baseline to Month 6
時間枠：Baseline and Month 6
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R5-R20 measured by impulse oscillometry (IOS).
R5 represents total airway resistance and R20 represents central airway resistance.
The difference between R5 and R20 (R5-R20) reflects small airway dysfunction.
Higher values indicate greater small airway impairment.
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Baseline and Month 6
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Change in Post-Bronchodilator FEV1 (% Predicted) From Baseline to Month 6
時間枠：Baseline and Month 6
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Post-bronchodilator forced expiratory volume in one second (FEV1), expressed as percent predicted, measured using standardized spirometry according to ATS/ERS recommendations.
Higher values indicate better lung function.
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Baseline and Month 6
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Anti-NTM Treatment Initiation
時間枠：Up to Month 6
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Proportion of Participants Requiring Anti-NTM Antibiotic Treatment
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Up to Month 6
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Adverse Events
時間枠：Up to Month 6
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Incidence of Adverse Events Related to Hypertonic Saline Inhalation
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Up to Month 6
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Within-Participant Change in Respiratory Severity Score During Normal Saline and Hypertonic Saline Treatment Periods in the Delayed-Initiation Arm
時間枠：Baseline to Month 6
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Comparison of RSS change during Months 0-3 while receiving nebulized normal saline and during Months 4-6 while receiving nebulized 3% hypertonic saline in participants assigned to the delayed-initiation arm.
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Baseline to Month 6
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Change in Respiratory Severity Score From Month 3 to Month 6 in the Early-Initiation Arm
時間枠：Month 3 and Month 6
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Evaluation of continued symptom improvement after the initial 3 months of hypertonic saline treatment.
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Month 3 and Month 6
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Change in Total RSS at Month 6
時間枠：Baseline and Month 6
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Total RSS ranges from 0 to 60 and is calculated from six visual analog scales evaluating cough, sputum production, dyspnea, fatigue, sleep disturbance, and overall respiratory symptoms.
Higher scores indicate worse symptoms.
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Baseline and Month 6
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その他の成果指標
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
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Change in Chest CT Findings From Baseline to Month 6
時間枠：Baseline and Month 6
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Chest CT findings including bronchiectasis, bronchiolitis (tree-in-bud pattern), nodules, consolidation, and cavitary lesions will be evaluated at baseline and Month 6 by comparison of serial CT scans.
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Baseline and Month 6
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Serum Carbohydrate Antigen 19-9 (CA19-9) Level
時間枠：Baseline, Month 3 and Month 6
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Change in serum carbohydrate antigen 19-9 (CA19-9) concentration from baseline to Months 3 and 6.
CA19-9 will be measured using a standard clinical laboratory assay.
Higher levels may reflect greater airway inflammation and disease burden in nontuberculous mycobacterial lung disease.
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Baseline, Month 3 and Month 6
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Serum Cancer Antigen 125 (CA125) Level
時間枠：Baseline, Month 3 and Month 6
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Change in serum cancer antigen 125 (CA125) concentration from baseline to Months 3 and 6.
CA125 will be measured using a standard clinical laboratory assay.
Higher levels may reflect greater pulmonary disease activity and extent of bronchiectatic involvement.
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Baseline, Month 3 and Month 6
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協力者と研究者
捜査官
- 主任研究者：Sheng-Wei Pan, MD, PhD、Taipei Veterans General Hospital, Taiwan
出版物と役立つリンク
一般刊行物
- Huiberts A, Zweijpfenning SMH, Pennings LJ, Boeree MJ, van Ingen J, Magis-Escurra C, Hoefsloot W. Outcomes of hypertonic saline inhalation as a treatment modality in nontuberculous mycobacterial pulmonary disease. Eur Respir J. 2019 Jul 11;54(1):1802143. doi: 10.1183/13993003.02143-2018. Print 2019 Jul. No abstract available.
- Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ Jr, Andrejak C, Bottger EC, Brozek J, Griffith DE, Guglielmetti L, Huitt GA, Knight SL, Leitman P, Marras TK, Olivier KN, Santin M, Stout JE, Tortoli E, van Ingen J, Wagner D, Winthrop KL. Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline. Clin Infect Dis. 2020 Aug 14;71(4):e1-e36. doi: 10.1093/cid/ciaa241.
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (推定)
研究の完了 (推定)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
キーワード
追加の関連 MeSH 用語
その他の研究ID番号
- HiNTM-01
- 114-2314-B-075 -079 (その他の助成金/資金番号：National Science and Technology Council, Taiwan)
- 2025-02-019A (その他の識別子：Taipei Veterans General Hospital)
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
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