A Cochrane review [Abstract] 1 included 12 studies with a total of 422 subjects aged 6 to 46 years. Compared to isotonic saline, hypertonic saline (3% to 7%, 10 ml twice-a-day) significantly increased forced expiratory volume at one second (FEV1) at 4 weeks (MD 4.15, 95% CI 1.14 to 7.16; 2 studies, n=205), but not significantly after 48 weeks (MD 2.31, 95% CI -2.72 to 7.34; 1 study, n=134). One 48-week study showed significant improvements in frequency of antibiotic use and quality of life with hypertonic saline compared to isotonic saline; also that hypertonic saline did not increase the concentration of Pseudomonas aeruginosa or Staphylococcus aureus.
Two studies compared a similar dose of hypertonic saline to recombinant deoxyribonuclease (RhDNAse): one three-week trial showed a non-significant difference (MD 1.60, 95% CI -7.96 to 11.16; n=14); in the second trial, after 12 weeks, RhDNAse led to a greater increase in FEV1 than hypertonic saline (5 ml twice-daily), in participants with moderate to severe lung disease (mean percentage change in FEV1, MD 8.00%, 95% CI 2.00 to 14.00%; n=48).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and by imprecise results (limited study size for each comparison).
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