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. 2017 Jan 12;4(1):e000168.
doi: 10.1136/bmjresp-2016-000168. eCollection 2017.

Timing of hypertonic saline and airway clearance techniques in adults with cystic fibrosis during pulmonary exacerbation: pilot data from a randomised crossover study

Katherine O'Neill  1 , Fidelma Moran  2 , Michael M Tunney  3 , J Stuart Elborn  1 , Ian Bradbury  4 , Damian G Downey  5 , Jackie Rendall  5 , Judy M Bradley  6
Affiliations

Timing of hypertonic saline and airway clearance techniques in adults with cystic fibrosis during pulmonary exacerbation: pilot data from a randomised crossover study

Katherine O'Neill et al. BMJ Open Respir Res. .

Abstract

Background: Streamlining the timing of treatments in cystic fibrosis (CF) is important to optimise adherence while ensuring efficacy. The optimal timing of treatment with hypertonic saline (HTS) and airway clearance techniques (ACT) is unknown.

Objectives: This study hypothesised that HTS before ACT would be more effective than HTS during ACT as measured by Lung Clearance Index (LCI).

Methods: Adults with CF providing written informed consent were randomised to a crossover trial of HTS before ACT or HTS during ACT on consecutive days. ACT treatment consisted of Acapella Duet. Patients completed LCI and spirometry at baseline and 90 min post treatment. Mean difference (MD) and 95% CIs were reported.

Results: 13 subjects completed the study (mean (SD) age 33 (12) years, forced expiratory volume in 1second % (FEV1%) predicted 51% (22), LCI (no. turnovers) 14 (4)). Comparing the two treatments (HTS before ACT vs HTS during ACT), the change from baseline to 90 min post treatment in LCI (MD (95% CI) -0.02 (-0.63 to 0.59)) and FEV1% predicted (MD (95% CI) -0.25 (-2.50 to 1.99)) was not significant. There was no difference in sputum weight (MD (95% CI) -3.0 (-14.9 to 8.9)), patient perceived ease of clearance (MD (95% CI) 0.4 (-0.6 to 1.3) or satisfaction (MD (95% CI) 0.4 (-0.6 to 1.5)). The time taken for HTS during ACT was significantly shorter (MD (95% CI) 14.7 (9.8 to 19.6)).

Conclusions: In this pilot study, HTS before ACT was no more effective than HTS during ACT as measured by LCI.

Trial registration number: NCT01753869; Pre-results.

Keywords: Cystic Fibrosis; Respiratory Measurement.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flow chart of recruitment.
Figure 2
Figure 2
Change in LCI with (A) HTS before ACT and (B) HTS during ACT (mean and 95% CIs). ACT, airway clearance treatment; HTS, hypertonic saline; LCI, Lung Clearance Index.
See this image and copyright information in PMC

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