Cystic fibrosis

Hypertonic saline well tolerated, effective, in CF exacerbations

Hypertonic saline is well tolerated, improves lung function and speeds the resolution of symptoms in people with cystic fibrosis who have been hospitalised with a pulmonary exacerbation, an Australian randomised trial finds.

Published in Thorax the trial led by physiotherapist Dr Ruth Dentice from the Royal Prince Alfred Hospital in Sydney involved 132 adults with an exacerbation of CF who were randomised to inhale three nebulised doses a day of either 4 mL 7% saline or a taste-masked control of 0.12% saline throughout their hospital admission.

Although the researchers did not meet the study’s primary endpoint of length of hospital stay (HS group hospital stay was 1 day shorter than placebo with 95% CI 0 to 2 days, P=0.07) they found patients had high adherence and tolerability to hypertonic saline.

Patients randomised to hypertonic saline also had a significantly greater reduction in symptom severity (sleep, congestion and dyspnoea) than the control group at discharge.

Furthermore the likelihood of regaining pre-exacerbation FEV1 by discharge was significantly higher in the hypertonic saline group (75% vs 57%).

A big issue in the management of CF was getting patients to regain their baseline FEV1 after an exacerbation so this finding was particularly important, said Dr Dentice in an interview with the limbic.

“This study shows that if patients are on HS during an exacerbation they are more likely to have a faster resolution of symptoms and to recover pre-exacerbation lung function by discharge” she said.

The findings around the tolerability of the treatment were also noteworthy as while the use of hypertonic saline was well established in clinical practice, there were concerns that people may not tolerate it when they were acutely unwell.

A number of centres were aware of people stopping the treatment during an exacerbation, or just not starting it, Dr Dentice explained.

“We felt we needed to answer the question is it tolerable and is it effective when you are acutely unwell,” she told the limbic.

“Everybody passed their first tolerance test so this study really did reassure us that we can say to people when they are acutely unwell, or if they are wondering about starting hypertonic, you can do it and you can take it in the presence of an exacerbation” she said.

“Overall the findings show that hypertonic saline is tolerable and effective to add into the treatment regimen both in hospital and at home,” she concluded.

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