Nebulised hypertonic saline for cystic fibrosis

Wark, Peter; McDonald, Vanessa M.; Jones, Ashley P

doi:10.1002/14651858.cd001506.pub2

Cited by 119 publications

(129 citation statements)

References 16 publications

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“…Hypertonic saline shifts the flow of water into the mucus layer by osmosis, reducing submucosal edema, reducing viscosity of mucus, improving mucus clearance, and rehydrating the air surface liquid. [17][18][19][20] The updated AAP guidelines support the use of hypertonic saline nebulization for infants and children hospitalized for bronchiolitis, except in the emergency department (ED) set-ting. 1 This recommendation was made based on evidence from randomized controlled trials with inconsistent findings in the ED setting.…”

Section: Therapy and Managementmentioning

confidence: 99%

Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

Baron

El-Chaar

2016

The Journal of Pediatric Pharmacology and Therapeutics

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Bronchiolitis, an infection of the lower respiratory tract, is the leading cause of infant and child hospitalization in the United States. Therapeutic options for management of bronchiolitis are limited. Hypertonic saline inhalation therapy has been studied in numerous clinical trials with mixed results. In 2014, the American Academy of Pediatrics (AAP) published updated guidelines on the diagnosis and management of bronchiolitis, which include new recommendations on the use of hypertonic saline. We reviewed all published clinical trials mentioned in the 2014 AAP guidelines, as well as additional trials published since the guidelines, and critically evaluated each trial to determine efficacy, safety, and expectations of hypertonic saline inhalation therapy. A total of 2682 infants were studied over the course of 22 clinical trials. Nine trials were carried out in the outpatient/clinic/emergency department and 13 in the inpatient setting. We agree with the AAP guidelines regarding the recommendation to use nebulized hypertonic saline for infants hospitalized with bronchiolitis, with the expectation of reducing bronchiolitis scores and length of stay when it is expected to last more than 72 hours. However, we also believe there might be an advantage for hypertonic saline in reducing admission rates from the emergency department, based on close examination of the results of recent trials. This review also highlights important gaps in the available literature that need to be addressed in order to define the role of inhaled hypertonic saline therapy.INDEX TERMS: bronchiolitis, hypertonic saline, infants, pediatrics, review J Pediatr Pharmacol Ther 2016;21(1):7-26

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Section: Therapy and Managementmentioning

confidence: 99%

Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

Baron

El-Chaar

2016

The Journal of Pediatric Pharmacology and Therapeutics

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“…Sufficient high-quality evidence (evidence level 1A) has been collected to recommend inhaled HS as an alternative mucolytic agent in CF treatment [55]. HS has a favorable effect on mucus rheology in vitro through hydration of the airway surface [40].…”

Section: Hypertonic Salinementioning

confidence: 99%

“…Nebulized HS can induce acute airway narrowing or bronchospasm and cough (Supplementary Tables 2), [11,[55][56][57][58][59][60][61][62][63][64][65][66][67][68][69] but in most cases these symptoms decrease after a few weeks so that the majority of patients find HS tolerable [55,62,63,68]. Rodwell et al were the first to describe acute airway responsiveness to inhaled 10% saline in a group of CF subjects with asthma-like symptoms [11].…”

Section: Hypertonic Salinementioning

confidence: 99%

Bronchial Hyperreactivity Related to Inhalation Therapy in Cystic Fibrosis Patients

Eyns¹

2014

J Pulm Respir Med

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It is presumed that bronchial hyperreactivity (BHR) can occur with any inhaled agent and may be a reason for discontinuation of inhalation therapy in cystic fibrosis (CF) patients. On the other hand, inhalation of antibiotics is being increasingly used to eradicate or treat infections.This review focuses on identifying the mechanisms of BHR for a better understanding of its impact on inhalation treatment. BHR in CF is suggested to be secondary to underlying airway disease (associated to poor pulmonary function, chronic inflammation and aerosol distribution) or to be a separate condition occurring more in CF. Furthermore, certain characteristics of the aerosol solution itself, such as the active molecule, chemical additives and particle size, can cause BHR.Recombinant human DNase (rhDNase), hypertonic saline (HS) and the antibiotics tobramycin, colistin and aztreonam lysine for inhalation (AZLI) are frequently used inhalation drugs in the treatment of CF. Prevalence of BHR related to both short and long-term inhalation of these drugs as reported in the literature was investigated. Acute BHR is documented in up to two thirds of CF patients. Despite the widespread use of rhDNase, HS, tobramycin, colistin and AZLI, only one long-term trial looked for, but did not demonstrate, BHR at the end of the trial period.

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“…Nebulization with 3-7% saline solution improves mucociliary clearance and lung function in a short period of time. (42) One recent clinical trial studied the nebulization of 4 mL of 7% hypertonic saline solution, administered for 48 weeks. (43) The authors demonstrated a significant improvement in lung function, a 56% reduction in the rates of exacerbation, and no worsening of the bacterial infection or the inflammation.…”

Section: Mucolytic Agentsmentioning

confidence: 99%

Fibrose cística no adulto: aspectos diagnósticos e terapêuticos

Dalcin¹,

Silva²

2008

J. bras. pneumol.

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Once considered a childhood disease, cystic fibrosis is now also a disease of adults. Increased longevity has resulted in the aging of the cystic fibrosis population. The consequent age-related medical problems among adults with cystic fibrosis have increased medical care needs. These needs are being met by a growing number of nonpediatric pulmonologists and other nonpediatric specialists. The objective of this review was to summarize the current knowledge about diagnosis and treatment in adult cystic fibrosis. In most cases, the diagnosis is suggested by manifestations of chronic sinopulmonary disease and exocrine pancreatic insufficiency. The diagnosis is confirmed by a positive sweat test result. Adult patients may, however, present pancreatic sufficiency and atypical clinical features, sometimes in combination with normal or borderline sweat test results. In such cases, identifying cystic fibrosis mutations and measuring nasal potential difference can have diagnostic utility. The standard therapeutic approach to pulmonary disease includes the use of antibiotics, airway clearance, exercise, mucolytics, bronchodilators, oxygen therapy, anti-inflammatory agents and nutritional support. Appropriate application of these therapies results in most cystic fibrosis patients surviving into adulthood with an acceptable quality of life.

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Nebulised hypertonic saline for cystic fibrosis

Cited by 119 publications

References 16 publications

Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

Bronchial Hyperreactivity Related to Inhalation Therapy in Cystic Fibrosis Patients

Fibrose cística no adulto: aspectos diagnósticos e terapêuticos

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