Effect of hypertonic saline, amiloride, and cough on mucociliary clearance in patients with cystic fibrosis.
In patients with cystic fibrosis (CF), dehydration of airway secretions leads to a decrease in mucociliary clearance (MCC). We examined the acute effect of MCC of a single administration by aerosolization of hypertonic saline (7%) (HS), amiloride (0.3% in 0.12% NaCl) (AML) and a combination of AML and HS (AML + HS) in 12 patients with CF using a radioaerosol technique. Isotonic saline [0.9%] (IS) was used as a control solution. As both the AML and HS solutions induced cough in some patients, the last nine patients studied also underwent a cough clearance day. This was to eliminate the possible confounding effect of cough on MCC measurement. Patients ranged from 18 to 28 yr (mean +/- SD, 22 +/- 3) with an FEV1 of 27 to 112% predicted (61 +/- 30%). Following deposition of the radioaerosol, baseline clearance was assessed for 30 min. This was followed by a 30-min intervention period. Assessment of post-intervention clearance for a further 30 min was then performed. Comparison of the amount of radioaerosol cleared from the right lung was made at 60 min (%C60) and 90 min (%C90) using repeated measures ANOVA. The percent cleared at 60 and 90 min was significantly increased with HS (%C60 = 26.5%, %C90 = 29.4%) and the combination of AML + HS (%C60 = 23.1%, %C90 = 27.4%) compared with both IS (%C60 = 14.7%, %C90 = 17.5%) and COUGH (%C60 = 18.0%, %C90 = 19.5%), p < 0.01. Inhalation of hypertonic saline is a potentially useful treatment in patients with cystic fibrosis.
Robinson
M
M
Respiratory Investigation Unit, Royal Prince Alfred Hospital, Sydney, Australia.
Regnis
J A
JA
Bailey
D L
DL
King
M
M
Bautovich
G J
GJ
Bye
P T
PT
D000293:Adolescent; D000328:Adult; D000336:Aerosols; D000584:Amiloride / Q000008:administration & dosage / Q000627:therapeutic use*; D000704:Analysis of Variance; D015986:Confounding Factors, Epidemiologic; D003371:Cough / Q000139:chemically induced / Q000503:physiopathology*; D003550:Cystic Fibrosis / Q000503:physiopathology* / Q000628:therapy; D004338:Drug Combinations; D005100:Expectorants / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D007552:Isotonic Solutions; D008168:Lung / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D009079:Mucociliary Clearance / Q000187:drug effects*; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000627:therapeutic use*; D013671:Technetium Tc 99m Sulfur Colloid
D000336:Aerosols; D004338:Drug Combinations; D005100:Expectorants; D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic; D013671:Technetium Tc 99m Sulfur Colloid; D000584:Amiloride