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Therapeutic effect of nebulized hypertonic saline for muco-obstructive lung diseases: a systematic review and
Yin Zhang1, Anchao Song2, Jingyue Liu1
1Department of Respiratory Disease, Chongqing Medical University Affiliated Children's Hospital, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Abstract:
Overproduction of mucus and impaired clearance play important roles in the pathogenesis of muco-obstructive lung diseases (MOLDs). This study aims to evaluate the therapeutic effect and safety of nebulized hypertonic saline (HS) on MOLDs. Five electronic databases including PubMed, Excerpt Medica Database (EMBASE), Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and International Standard Randomized Controlled Trial Number Register were searched until June 2019. Randomized controlled trials or randomized controlled crossover trials which investigated the therapeutic effect of HS versus non-HS for MOLDs were included. Twenty-one studies met the eligibility criteria. For cystic fibrosis (CF), although the forced expiratory volume in the first second and forced vital capacity did not improve significantly (mean difference (MD) -0.48, 95% CI -3.72 to 2.76), (MD 1.85, 95% CI -4.31 to 8.01), respectively), the clearance capability of lung and quality of life (QOL) improved significantly in the HS group ((standard mean difference 0.44, 95% CI 0.02 to 0.87), (MD -0.64, 95% CI -)1.14, to 0.13), respectively). However, the results of trial sequential analysis showed the evidence needed more researches to support. The effect of nebulized HS on non-CF bronchiectasis, chronic obstructive pulmonary disease, and primary ciliary dyskinesia also need more evidence to conclude, since current studies are limited and results are inconsistent. Most adverse events of nebulized HS were mild and transient. In summary, the current available evidence suggests that nebulized HS may increase the QOL in CF, but there was no significant improvement in lung function. However, it is not possible to draw firm conclusions for other MOLDs due to limited data.
Insights
Nebulized hypertonic saline (HS) may improve quality of life in cystic fibrosis (CF) patients, but lung function showed no significant improvement. More research is needed for other muco-obstructive lung diseases (MOLDs).
Area of Science:
- Pulmonary Medicine
- Respiratory Physiology
- Clinical Therapeutics
Background:
- Muco-obstructive lung diseases (MOLDs) are characterized by mucus overproduction and impaired clearance.
- Nebulized hypertonic saline (HS) is a potential therapeutic agent for improving mucus clearance.
Purpose of the Study:
- To evaluate the therapeutic effects and safety of nebulized HS in patients with MOLDs.
- To synthesize current evidence from randomized controlled trials on nebulized HS for MOLDs.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials and crossover trials.
- Searched five major electronic databases up to June 2019.
- Included 21 studies investigating HS versus non-HS interventions for MOLDs.
Main Results:
- In cystic fibrosis (CF), nebulized HS significantly improved lung clearance and quality of life (QOL), but not forced expiratory volume or forced vital capacity.
- Evidence for nebulized HS in non-CF bronchiectasis, COPD, and primary ciliary dyskinesia is limited and inconsistent.
- Trial sequential analysis indicated a need for further research to confirm findings in CF.
Conclusions:
- Nebulized HS may enhance QOL in CF patients, though lung function benefits are not significant.
- Current evidence is insufficient to draw firm conclusions for other MOLDs due to limited and inconsistent data.
- Nebulized HS appears generally safe, with most adverse events being mild and transient.
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