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Nebulised hypertonic saline for cystic fibrosis
P A B Wark1, V McDonald, A P Jones
1Respiratory Medicine HMRI, Level 3 John Hunter Hospital, Locked Bag 1 HRMC, Newcastle, New South Wales, Australia, NSW 2310. peter.wark@hnehealth.nsw.gov.au
The Cochrane Database of Systematic Reviews
|July 22, 2005
Summary
Nebulised hypertonic saline improves mucociliary clearance and lung function in cystic fibrosis patients compared to placebo. However, it may be less effective than recombinant deoxyribonuclease for long-term lung function improvement.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Pharmacology
Background:
- Cystic fibrosis (CF) lung disease is characterized by impaired mucociliary clearance.
- Hypertonic saline (HS) has demonstrated in vitro ability to enhance mucociliary clearance.
- Enhanced mucociliary clearance may mitigate airway inflammation and damage in CF.
Purpose of the Study:
- To evaluate the efficacy of nebulised hypertonic saline in individuals with cystic fibrosis.
- To compare hypertonic saline treatment against placebo and other mucociliary clearance-enhancing therapies.
- To assess the impact of hypertonic saline on lung function and mucociliary clearance in CF patients.
Main Methods:
- Systematic review of controlled trials identified through the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register.
- Inclusion criteria encompassed all controlled trials comparing hypertonic saline to placebo or other mucolytic agents in CF patients.
- Data extraction and quality assessment were performed independently by two authors, including allocation concealment.
Main Results:
- Nine trials involving 235 participants (ages 6-46) met the inclusion criteria.
- Short-term studies showed hypertonic saline significantly increased isotope clearance compared to control.
- Four trials indicated a significant improvement in forced expiratory volume at one second (FEV1) with hypertonic saline (10 ml, 3-7% saline, twice-daily) versus placebo.
- Comparison with recombinant deoxyribonuclease showed mixed results; one trial found no significant difference, while another indicated recombinant deoxyribonuclease was more effective for FEV1 improvement after 12 weeks.
Conclusions:
- Nebulised hypertonic saline effectively improves mucociliary clearance and lung function in the short term compared to placebo in cystic fibrosis patients.
- Hypertonic saline may be less effective than recombinant deoxyribonuclease in improving lung function over a three-month period.
- Insufficient evidence currently supports the routine use of hypertonic saline for all individuals with cystic fibrosis.