Hyaluronic acid improves "pleasantness" and tolerability of nebulized hypertonic saline in a cohort of patients with cystic fibrosis.
BACKGROUND
Inhaled hypertonic saline improves lung function and decreases pulmonary exacerbations in people with cystic fibrosis. However, side effects such as cough, narrowing of airways and saltiness cause intolerance of the therapy in 8% of patients. The aim of our study was to compare the effect of an inhaled solution of hyaluronic acid and hypertonic saline with hypertonic solution alone on safety and tolerability.


METHODS
A total of 20 patients with cystic fibrosis aged 6 years and over received a single treatment regimen of 7% hypertonic saline solution or hypertonic solution with 0.1% hyaluronate for 2 days nonconsecutively after a washout period in an open crossover study. Cough, throat irritation, and salty taste were evaluated by a modified ordinal score for assessing tolerability; "pleasantness" was evaluated by a five-level, Likert-type scale. Forced expiratory volume in 1 second was registered before and after the end of the saline inhalations.


RESULTS
All 20 patients (nine males, 11 females, mean age 13 years, range 8.9-17.7) completed the study. The inhaled solution of 0.1% hyaluronic acid and hypertonic saline significantly improved tolerability and pleasantness compared to hypertonic saline alone. No major adverse effects were observed. No difference was documented in pulmonary function tests between the two treatments.


CONCLUSIONS
Hyaluronic acid combined with hypertonic saline solution may contribute to improved adherence to hypertonic saline therapy. Further clinical trials are needed to confirm our findings. Considering the extraordinary versatility of hyaluronic acid in biological reactions, perspective studies could define its applicability to halting progression of lung disease in cystic fibrosis.
Department of Pediatrics, University of Naples Federico II, Italy. buonpens@unina.it
Paolo
P
Buonpensiero
Fabiola
F
De Gregorio
Angela
A
Sepe
Antonio
A
Di Pasqua
Pasqualina
P
Ferri
Maria
M
Siano
Vito
V
Terlizzi
Valeria
V
Raia
D000293:Adolescent; D000336:Aerosols; D002648:Child; D003371:Cough / Q000139:chemically induced / Q000517:prevention & control; D018592:Cross-Over Studies; D003550:Cystic Fibrosis / Q000188:drug therapy*; D005100:Expectorants / Q000009:adverse effects / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects / Q000494:pharmacology*; D008297:Male; D009079:Mucociliary Clearance; D010349:Patient Compliance; D010612:Pharyngitis / Q000139:chemically induced / Q000517:prevention & control; D011788:Quality of Life; D012462:Saline Solution, Hypertonic / Q000009:adverse effects / Q000494:pharmacology*; D013649:Taste
D000336:Aerosols; D005100:Expectorants; D012462:Saline Solution, Hypertonic; D006820:Hyaluronic Acid