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Evidence summaries

Nebulised Hypertonic Saline for Cystic Fibrosis

Treatment with hypertonic saline for 48 weeks may lead to a small improvement in lung function at four weeks compared to isotonic saline, but this effect may not sustain for long term. However, it appears to improve quality of life and reduce pulmonary exacerbations over the 48 weeks. Level of evidence: "C"

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).

    References

    • Wark P, McDonald VM. Nebulised hypertonic saline for cystic fibrosis. Cochrane Database Syst Rev 2009;(2):CD001506[PubMed]

Primary/Secondary Keywords