Salt therapy in practice – A guide for healthcare professionals

Definitions and terminology

The literature contains several interrelated concepts. Knowing precise terminology is essential for interpreting the scientific literature.

Historical background

The modern history of salt therapy began in 1843 when Feliks Boczkowski, a Polish physician, observed an unusually low incidence of respiratory diseases among workers in the Wieliczka salt mine. This observation led to the establishment of the first speleotherapy sanatorium.

Europe's best-known speleotherapy centers still operate today:

• Wieliczka Salt Mine (Poland) – a health center for respiratory rehabilitation located 135 meters deep in the UNESCO World Heritage mine
• Turda Salt Mine / Salina Turda (Romania) – operating as a halotherapy center and tourist attraction since 1992, 112 meters deep

In the second half of the 20th century, the Soviet Union and Eastern Europe conducted intensive research into speleotherapy and later into artificial halotherapy. The first halo generators were developed in the 1980s, enabling reproduction of cave microclimates in clinical settings.

Mechanisms of action

Halotherapy exerts complex effects at several levels:

1. Improvement of mucociliary clearance

Inhaled NaCl particles, by their osmotic effect, attract water into the periciliary fluid layer, reducing mucus viscosity. Thinner secretions are more easily mobilized by the cilia. Bennett and colleagues (2021) demonstrated that inhalation of hypertonic saline acutely and durably improves mucociliary clearance in adults with asthma.¹

2. Anti-inflammatory effects

Salt particles may reduce levels of airway inflammatory mediators. In a randomized trial by Bar-Yoseph et al. (2017), halotherapy significantly reduced fractional exhaled nitric oxide (FeNO) in children with asthma, indicating reduced airway inflammation.²

3. Reduction of bronchial hyperreactivity

The same study showed that halotherapy decreased methacholine-provoked bronchial hyperreactivity, a central element in asthma pathophysiology.²

4. Antimicrobial effects

NaCl has natural antibacterial properties. In vitro studies have shown inhibitory effects of salt on certain respiratory pathogens, although the clinical significance requires further research.

Evidence by indication

Asthma

The strongest evidence is available in the field of asthma.

Bar-Yoseph et al. (2017) – Randomized, double-blind, controlled trial in 5–13-year-old children with mild asthma (n=29). Halotherapy significantly improved bronchial hyperreactivity (p=0.04), reduced FeNO (p=0.02), and improved quality of life. No adverse events were reported.²

Crișan-Dabija et al. (2021) – Systematic review of 18 original articles. Conclusion: halotherapy "may be a reliable adjunct therapy alongside allopathic treatment" in asthma.³

Evidence level: Moderate-strong (1 RCT, several observational studies, systematic review)

COPD

Evidence in COPD is weaker but promising.

Rashleigh et al. (2014) – Systematic review of halotherapy in COPD. The authors noted methodological limitations in existing studies, but available data suggest halotherapy may be a potentially useful adjunctive therapy.⁴

Evidence level: Low–moderate (observational studies, methodological limitations)

Cystic fibrosis

For cystic fibrosis, evidence for inhaled hypertonic saline (nebulized) is strong, whereas specific studies on dry halotherapy are limited.

Evidence level: Strong for nebulized hypertonic saline; limited for dry halotherapy

Rhinosinusitis

Nasal irrigation with saline is one of the best-documented applications.

Cochrane review (2016) – Nasal irrigation with saline is "well tolerated" and recommended as an adjunctive treatment in chronic rhinosinusitis.⁵

Liu et al. (2020) – Meta-analysis of 7 RCTs: hypertonic saline was significantly more effective than isotonic saline in reducing symptoms of chronic rhinosinusitis.⁶

Evidence level: Strong (Cochrane review, meta-analysis)

Summary evidence table

Practical protocols

Halotherapy chamber (salt room) – Standard protocol

Home halotherapy – Recommended protocol

Use of salt therapy devices at home requires a different protocol:

The advantage of home devices is longer exposure time, which compensates for the lower salt concentration.

Before starting treatment

For safe application, know the indications and contraindications.

Indications

• Asthma (mild–moderate, in a controlled state)
• COPD (in stable phase)
• Chronic bronchitis
• Chronic rhinosinusitis
• Allergic rhinitis
• Cystic fibrosis (as an adjunct therapy)
• Recurrent respiratory infections (prevention)
• Chronic cough due to smoking

When NOT to use it?

Absolute contraindications:

• Active tuberculosis
• Airway bleeding, hemoptysis
• Severe heart failure (NYHA III–IV)
• Acute respiratory infection with fever
• Active malignancy undergoing treatment (consultation required)

Relative contraindications (require individual assessment):

• Untreated or unstable hypertension
• Severe kidney disease
• Hyperthyroidism
• Claustrophobia (in case of salt room)
• Acute asthma exacerbation

Possible adverse effects

Halotherapy is generally well tolerated. Documented adverse effects in the literature include:

• Common (>10%): Transient increase in cough (a sign of secretion mobilization)
• Occasional (1–10%): Mild throat or nasal irritation, rhinorrhoea
• Rare (<1%): Headache, dizziness
• Very rare: Bronchospasm (in hyperreactive patients)

The 2017 Israeli RCT did not find significant adverse effects in the halotherapy group compared with control.²

Integration into clinical practice

When do we recommend halotherapy?

1. Alongside optimized pharmacological treatment – Halotherapy complements, it does not replace, standard therapy
2. When patient motivation and compliance are adequate – Regular use is key
3. When a drug-free alternative is desired – Particularly in children or during pregnancy
4. To spare steroids – May be considered in well-controlled asthma

Patient communication

It is important that patients start halotherapy with realistic expectations:

• An adjunct method, not a cure-all
• Results are expected after 2–4 weeks
• Consistency is more important than intensity
• Do not stop prescribed medications

Home devices from a professional viewpoint

Home halotherapy devices – such as the SaltDome – enable long-term, regular use, which may be advantageous for clinical effectiveness.

Advantages in professional practice:

• Improved patient compliance (home convenience)
• Longer exposure time (nighttime use)
• Cost-effective in the long term
• Can also be used for prevention

Considerations:

• Salt concentration is lower than in professional salt rooms
• Longer exposure may compensate for lower concentration
• Patient education is necessary for correct use

Summary – Quick overview

What is this article? A professional guide on the evidence, protocols and clinical application of halotherapy (salt therapy) for healthcare professionals.

Who is it for? Physicians, physiotherapists, respiratory therapists, rehabilitation specialists and other healthcare professionals treating patients with respiratory conditions.

Main message: Halotherapy is an evidence-based adjunctive therapy for certain respiratory conditions, particularly asthma and chronic rhinosinusitis. The method is safe, well tolerated, and can be integrated into clinical practice with appropriate patient selection.

Related guides

• Salt therapy and halotherapy – Comprehensive guide to respiratory health
• Asthma and salt therapy – Natural respiratory support
• COPD and salt therapy – Easier breathing, better quality of life
• Cystic fibrosis and salt therapy – Secretion loosening and respiratory support

References

1. Bennett WD, et al. (2021). Acute and durable effect of inhaled hypertonic saline on mucociliary clearance in adult asthma. ERJ Open Research, 7(1):00062-2021. PMC article
2. Bar-Yoseph R, et al. (2017). Halotherapy as asthma treatment in children: A randomized, controlled, prospective pilot study. Pediatric Pulmonology, 52(5):580-587. PubMed: 27723955
3. Crișan-Dabija R, et al. (2021). Halotherapy—An Ancient Natural Ally in the Management of Asthma: A Comprehensive Review. Healthcare, 9(11):1604. PubMed: 34828649
4. Rashleigh R, Smith SM, Roberts NJ. (2014). A review of halotherapy for chronic obstructive pulmonary disease. International Journal of COPD, 9:239-246. PubMed: 24591823
5. Chong LY, et al. (2016). Saline irrigation for chronic rhinosinusitis. Cochrane Database of Systematic Reviews, 4(4):CD011995. PubMed: 27115216
6. Liu L, et al. (2020). Efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis: systematic review and meta-analysis. Brazilian Journal of Otorhinolaryngology, 86(5):639-646. PubMed: 32534983

The information in this article is provided for professional guidance. The use of halotherapy requires individual assessment, taking into account the patient’s condition, comorbidities and the available evidence. Home therapeutic devices are intended to complement medical treatment and do not replace specialist care.