New Study Shows Hypertonic Solution Cures Everything

Back in the 1970s, doctors frequently prescribed hypertonic saline (salt water) as a treatment. The idea was that the salty solution would draw water out of the airways, thinning mucus and making it easier to cough up. However, this theory was later disproved, and by the 1990s, hypertonic saline was largely phased out as an aerosolized treatment.

Fast forward to 2020, and a shift in medical thinking emerged: the longer the treatment, the better the potential outcome. This led to renewed interest in hypertonic saline, particularly for cases involving mucus plugging, often identified through X-rays or CT scans.

Common symptoms:  Excessive mucus production tied to conditions like asthma, COPD, or bronchiectasis—or sometimes, a vague “other” category when the cause isn’t entirely clear but the treatment is worth trying.

Frequency: Typically prescribed every six hours.

Effect: Designed to thin mucus by creating a hydrating, salt-infused "hurricane" in the airways. Even if no visible sputum is produced, the treatment is believed to work on a microscopic level.

Annoying CT Results? Maybe Pulmicort Can Save the Day!

Doctors are supposed to practice evidence-based medicine—prescribing treatments backed by solid research, clear indications, and measurable benefits. But what happens when they start making things up?

Take this case: a patient  who recently had a CT scan. The scan showed "a few tree-in-bud infiltrates, which could indicate infection, inflammation, or aspiration." according to the report. There were also no systemic signs of infection. 

The doctor wrote in his notes: "Will trial Pulmicort for this." He followed through and prescribed Pulmicort (budesonide) at 0.25 mg BID—a pediatric dose nonetheless.

The problem? Aside from the pediatric dose, the CT scan alone doesn’t justify ICS therapy. There aren’t any well-established studies supporting this approach. In fact, I doubt it has even been studied. In fact, I even used AI to try to find one, and AI came up empty. That says a lot.

So why did the doctor prescribe it anyway?

Possible Explanations (None of Them Good)

• Guesswork – The doctor doesn’t know what to do and is throwing an ICS at the problem, hoping for the best.
• Overtreatment Culture – Some doctors feel the need to “do something,” even when doing nothing is the better option.
• Misinterpretation of Evidence – The doctor may think ICS reduces inflammation in any lung condition, despite the lack of proof for this scenario.
• Covering Their Bases – Writing a prescription makes it look like they’re addressing the issue, even if there’s no clear benefit.

What the Science Actually Says

There’s no established research supporting the use of ICS in asymptomatic patients based solely on CT findings. Worse, unnecessary ICS use carries risks: increased susceptibility to pneumonia, and oral thrush.

The Bigger Issue: When Doctors Prescribe Without Evidence

This isn’t just about one bad prescription—it’s about a broader problem in medicine. When doctors ignore evidence-based guidelines and prescribe treatments without justification, it doesn’t necessarily undermine patient trust. Most patients don’t question what they’re given; they simply accept what the doctor orders.

The people who do question these decisions? Respiratory therapists like me—the ones actually administering the treatments. We see firsthand that these treatments are a waste of time and money. When there’s no clear benefit, no solid evidence, and no logical reason for a prescription, it’s frustrating to be the one carrying it out. Instead of blindly following orders, we should be asking the real question: Why are we doing this in the first place?

Medicine should be guided by science, not guesswork.

Final Thoughts

When doctors prescribe treatments without solid evidence, they’re not helping patients—they’re relying on assumptions. That’s a problem.

Meanwhile, the doctor might feel good about “doing something.”
But to me, it’s just another pointless task.

And for the patient?
It’s one more unnecessary treatment.

Sadly, there's a lot of this type of waste in healthcare. 

Your Thoughts: What do you think is the most interesting aspect of being an RT?

A while back, I conducted a highly scientific survey. I asked readers to email me (you can find the link in the right column if you want to chime in!) with their answers to this pressing question:

"What do you think is the most interesting aspect of being a respiratory therapist? Sarcasm welcome."

Now, I’ll admit—this wasn’t exactly a formal study. Let’s just say the results are more qualitative than quantitative. But hey, why let facts get in the way of a good blog post?

What follows is a collection of insights, anecdotes, and observations that definitely aren’t my own sarcastic takes on the job. Nope, totally not mine. These are purely the thoughts of my loyal readers—who, for all I know, could also be my bosses.

1. We could write off nearly all breathing treatments and not one discharge would be impacted. 
2. I find it interesting how so many doctors and nurses think an asthma medicine will cure all annoying lung sounds and ailments.
3. All wheezes are to be considered bronchosasm -- according to most doctors -- and treated as such.
4. No study needed: If it sounds good just order it -- who cares if it really works. 
5. Why is it that in the hospital setting all we do is nebulizers. Why can't we ever do inhalers? And then when preventative inhalers are ordered, doctors still order Q4 nebulizers of the same medicine. Huh?
6. Most of what we do is a waste of time or delays time (This is an actual quote from a wise respiratory therapist I will not name who used to work for the AARC). 
7. Nothing like treating post-op atelectasis with yet another nebulizer. Because obviously, albuterol is magical and can heal incisions, fix pain, and force patients to deep-breathe. Who needs incentive spirometers when we have bronchodilators?
8. Q-forever. You can dc it via protocol if you deem it as useless. But the doctor will just re-order it. So why have protocols in the first place? 

So, there you have it—a not-so-scientific collection of observations, gripes, and sarcastic takes from some of you. As respiratory therapists, we see the absurdities of the job every day, and sometimes, all we can do is laugh (or sigh heavily into our masks). If you’ve got your own stories, insights, or sarcastic gems to share, I’d love to hear them! Drop me an email—there’s a handy link in the right column of this blog. Who knows? Your wit and wisdom might just inspire the next round of this "survey."

Navigating life around flare-ups can certainly be done

My Gymnast.

When you have asthma, sometimes you have to do things a little differently than other people. That’s just how it is. You learn to adapt, make adjustments, and—most importantly—listen to your body. Some days, that means skipping out on fun. Other days, it means letting your girlfriend scrape her own windshield in the middle of a snowstorm.

Two days ago, it was a beautiful 70 degrees. After a long winter, it was nice to see people outside again. Moms and dads were out with their kids—yelling, laughing, bouncing basketballs, jumping on trampolines. People walked their dogs, chatting as they strolled through the neighborhood. Even my kids and I were outside, tossing a baseball back and forth. From the outside, I probably looked like a normal dad, enjoying the fresh air with his kids. But inside, I felt it—that tightness in my chest, the ever-present urge to cough. It sat deep in my lungs, a reminder that even on the best days, my asthma was always there. It as on this day I decided to start my 5 day course of 40 mg of steroids. 

 

Yesterday was just as nice as the day before, but I spent most of it inside. My daughter, Laney, had a Girl Scouts meeting in Muskegon, so we drove the hour and I dropped her off early in the morning. Then, I had to sit through a parent meeting. It was informative—I learned about her upcoming trip to the island for a Girl Scout event in July—but after about 30 minutes, they opened the floor to questions. And, of course, the unnecessary questions started, stretching the meeting to an hour.

Finally, I escaped and met my girlfriend for lunch. The Girl Scout meeting was in Muskegon, an hour from Shoreline, so after lunch, we found a nice spot on the beach to hang out for a few hours. Despite the warm weather, the lakefront was cooler, with high waves crashing on the shore. We walked to a bench overlooking the water but found it too windy and cold to sit. Instead, we opted to stay in the car, playing the day’s episode of The Bible in a Year with Fr. Mike Schmitz.

My asthma had been acting up for weeks, making it difficult to play catch with Laney the day before, and nearly impossible to work out. So, in a way, being stuck in meetings and sitting in a car all day was probably good for me. If I had been home, I’d have found something to do—like cleaning the garage—something my lungs wouldn’t have appreciated.

By 3 p.m., we left the beach to pick up Laney and drop her off at gymnastics. Meets take time, and while it's fun to see the girls' progress, after two hours on a hard bench—with two more to go—it gets tough. Eventually, I stepped outside to take a break, only to find that my car battery had died.

I went back inside, now short of breath and struggling to talk. Years of dealing with severe asthma as a child made me good at pretending I was fine, but my girlfriend saw through it right away. She told me to sit and take it easy, but I was determined to fix my car. She moved her car next to mine while I set up the jumper cables, and we got it started. Being from a big city, she was cautious about leaving a running car unattended. I, on the other hand, was less concerned, but she stayed outside in her car just to be safe while I went back in for the awards ceremony. What a good person she is. 

Once it wrapped up, Laney and I headed home. Jean drove in her own car, being that Muskegon was our half way point -- she lives in Grand Rapids. We stopped at Subway for dinner, where she noted, “It’s been 12 hours since I ate.” And I thought this was an odd comment, because she did pack a lunch. And she also said earlier that she had donut. 

And then, because this is Michigan, a snowstorm hit the next day. We went from almost no snow to at least 2–3 feet overnight. My girlfriend joined us for church, then we spent the day playing games with the kids and making burritos. Later, we sat on the couch by the large picture window, watching the snow fall hard. It kept coming down the whole time, blanketing everything outside.

When it was time for her to leave, I walked her to her car in my shorts, grateful that my asthma was finally improving after three days on steroids. Still, I knew I had to take it easy to avoid another flare-up. She started her car but didn’t let it warm up long enough to clear the ice from the windows. Grabbing a scraper, she handled it herself.

I noticed my neighbor Dave watching from across the street. I imagined he thought I was a terrible boyfriend for letting her scrape her own windows in the snow. But the truth is, people usually aren’t judging us as much as we think. And even if he was, I knew there was a good reason I wasn’t out there helping—sometimes, when you have a chronic illness, you have to make adjustments to protect your health.

Today is Monday, and my lungs feel so much better. In a few hours, I’ll put them to the test—I plan to clean and organize my basement to make room for a new weight bench arriving soon. My goal this spring and summer is to lose weight and get in shape, which should help my lungs too.

Fit testing time again, and again, and again...

Ah, fit testing season is upon us once again—the annual ritual where we confirm that the mask we’ve been wearing all year still fits. Because, of course, logic demands it. Nothing says "efficiency" like repeating a test for something you already know the answer to. Bureaucracy at its finest!

This tradition is brought to you by none other than OSHA—the overlords of occupational safety—and their local enforcers, MIOSHA. These fine folks ensure that anyone donning an N95 mask to fend off airborne germs is officially deemed fit to do so. And not just once, mind you. No, we must endure this spectacle every single year. Why? Because... well, because.

Seriously, didn’t we just do this? Oh wait, that was last year. And now it’s time again, because seven people sitting in ridiculously expensive leather chairs needed to justify their existence. So, they came up with a rule: Annual fit testing! That way, when they visit our hospital, they have something to check off their clipboard.

But let’s not forget the hidden genius of this policy: It doubles as a convenient way for the hospital to deal with "that guy." You know the one—the person nobody likes but HR hasn’t found a good excuse to fire. Skip your fit test this year? Boom. You’re fired. Thanks for playing.

Now, let’s talk about logic. The only time fit testing should be necessary is when something significant changes—like if you’ve gained or lost a lot of weight or decided to embrace your inner lumberjack and grow a full beard. But apparently, common sense isn’t part of the rulebook. Instead, we’re stuck in a cycle of pointless repetition, because doing things the logical way would be far too convenient.

So here we are, dutifully squeezing into masks we’ve already proven fit us perfectly, all for the sake of compliance. Not like we have enough to do already... right?

A Personal Reflection on Coping

As a kid, I received counseling for my anxiety. I now understand that this fear is irrational. Through therapy, I learned strategies to help me live a normal life despite my anxiety. For example, I learned that the feelings I experience in these situations are not typical, and no one else in the room is feeling what I feel. I’ve learned to simply go about my business and manage these feelings as best as I can.

I'm The Best At Drawing ABGs

I went into Room 2 to do an ABG. The guy was an end-stage COPDer, but he wasn’t in any respiratory distress. So, I sat next to him, chatted a bit while prepping my ABG kit, and then felt for his pulse.

"I'm not going to poke you right away," I told him. "I'll let you know when I'm ready." I like to take my time so that when I do poke, I find the best spot.

When I finally inserted the needle, the blood flowed smoothly and quickly into the syringe. The patient was impressed.

"Wow," he said. "You're good. That didn’t even hurt."

I grinned. "I know. I don’t waste time missing anymore. Back when I was younger, I’d miss every now and then. But now, I just get it right away and be done with it—so I can spend more time in the RT Cave."

He laughed. "You’re really funny. I like that."

"Well, thanks," I said.

The next day, I had to draw his blood gas again. As soon as I told him, he said, "Oh, good! You’re the guy who’s really good at it."

I shook my head. "Wait a minute. You’re not supposed to be overconfident, arrogant, and condescending about my work until after I draw. Now you may have just jinxed me."

He laughed again.

I prepped, gave my usual warning about letting him know before I poked, and took my time finding the perfect spot. Then I inserted the needle—slowly—and… nothing.

"See what I mean?" I said.

I readjusted, and this time, I got it.

"There. Now you know why you don’t say anything until after."

"But you still got it," he said. "Man, you’re good. Better than anyone else who’s poked me."