Hypertonic Saline Inhalation for Mycobacterium Avium Complex Pulmonary Disease

Inclusion Criteria:

• International guideline criteria for nodular-bronchiectatic MAC lung disease, i.e.symptomatic, nodular bronchiectatic lesions seen on thorax radiography and ≥2positive cultures of the same MAC species or one positive culture from abronchoalveolar lavage;

• ≥1 positive MAC sputum cultures must be collected in the previous 4 months;

• Signed and dated patient informed consent.

Exclusion Criteria:

• Fibrocavitary MAC lung disease;

• Antimycobacterial treatment in the last 6 months;

• Previous MAC lung disease treatment failure, defined as persistent culturepositivity despite >6 months of guideline-recommended treatment;

• Current clinical relevant asthma or otherwise bronchial hyperresponsiveness that isjudged to be a contra-indication for HSi.

• Current HSi use

• Former adverse reaction to HSi (note: former HSi use that was stopped due to a lackof clinical improvement is not an exclusion criterium);

• Hypertonic saline intolerability during the screening test inhalation

• Diagnosis of HIV;

• Diagnosis of Cystic fibrosis (CF);

• Active pulmonary malignancy (primary or metastatic) or any other malignancyrequiring chemotherapy or radiotherapy within 6 months before screening oranticipated during the study period;

• Active pulmonary tuberculosis, fungal or nocardial disease requiring treatment

• Current use of chronic systemic corticosteroids at doses of 15 mg/day for more than 3 months

• Prior lung or other solid organ transplant

• Known or suspected current drug or alcohol abuse, that is, in the opinion of theInvestigator, sufficient to compromise the safety or cooperation of the patient.