Salt therapy in practice – a guide for healthcare professionals

Definitions and terminology

Several related concepts appear in the literature. Knowing precise terminology is essential for interpreting the scientific literature.

Historical background

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

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

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

In the second half of the 20th century, intensive research into speleotherapy and later artificial halotherapy took place in the Soviet Union and Eastern Europe. The first halogenerators were developed in the 1980s, enabling reproduction of the salt cave microclimate in a clinical environment.

Mechanisms of action

Halotherapy exerts complex mechanisms at multiple levels:

1. Improvement of mucociliary clearance

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

2. Anti-inflammatory effect

Salt particles may reduce levels of airway inflammatory mediators. Bar-Yoseph and colleagues (2017) in a randomized trial found that halotherapy significantly reduced exhaled nitric oxide (FeNO) in asthmatic children, indicating decreased airway inflammation.²

3. Reduction of bronchial hyperresponsiveness

The same study showed that halotherapy reduced bronchial hyperresponsiveness provoked by methacholine, a central element of asthma pathophysiology.²

4. Antimicrobial effect

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

Evidence by indication

Asthma

We have the strongest evidence 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 hyperresponsiveness (p=0.04), reduced FeNO (p=0.02) and improved quality of life. No adverse effects were reported.²

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

Evidence level: Moderate–strong (1 RCT, multiple 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 concluded that available data suggest halotherapy could be a potentially useful adjunctive therapy.⁴

Evidence level: Weak–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; weak 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 home salt therapy devices requires a different protocol:

The advantage of home devices is the 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 (stable phase)
• Chronic bronchitis
• Chronic rhinosinusitis
• Allergic rhinitis
• Cystic fibrosis (as adjunctive therapy)
• Recurrent respiratory infections (prevention)
• Chronic cough due to smoking

When NOT to use?

Absolute contraindications:

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

Relative contraindications (individual assessment required):

• Untreated or unstable high blood pressure
• Severe kidney disease
• Hyperthyroidism
• Claustrophobia (in the case of a salt room)
• Acute asthmatic exacerbation

Possible adverse effects

Halotherapy is generally well tolerated. Adverse effects documented in the literature:

• Common (>10%): Transient increase in cough (a sign of secretion mobilization)
• Occasional (1–10%): Mild throat or nasal irritation, rhinorrhea
• 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 controls.²

Integration into clinical practice

When do we recommend halotherapy?

1. Alongside optimized pharmacological therapy – halotherapy complements, not replaces, standard treatment
2. When patient motivation and compliance are adequate – regular use is key
3. When a drug-free alternative is desired – especially for children or during pregnancy
4. For steroid-sparing purposes – may be considered in well-controlled asthma

Patient communication

It is important that patients start halotherapy with realistic expectations:

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

Home devices from a professional perspective

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

Advantages in professional practice:

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

Considerations:

• Salt concentration is lower than in professional salt rooms
• Longer exposure can 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 therapists and other healthcare professionals who treat respiratory patients.

Main message: Halotherapy is an evidence-based adjunctive therapy for certain respiratory conditions, especially 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 breathing support
• COPD and salt therapy – Easier breathing, better quality of life
• Cystic fibrosis and salt therapy – Secretion clearance 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 for professional informational purposes. The use of halotherapy requires individual assessment taking into account the patient’s condition, comorbidities and the available evidence. Home therapeutic devices serve to complement medical treatment and do not replace specialist care.