title: Nebulized hypertonic saline via positive expiratory pressure versus via jet nebulizer in patients with severe cystic fibrosis.
abstract: BACKGROUND
  Nebulized hypertonic saline is a highly effective therapy for patients with cystic fibrosis (CF), yet 10% of patients are intolerant of hypertonic saline administered via jet nebulizer. Positive expiratory pressure (PEP) nebulizers splint open the airways and offers a more controlled rate of nebulization.
  
  
  METHODS
  In 4 consecutive adult CF patients who were intolerant of hypertonic saline via jet nebulizer, we nebulized 6% hypertonic saline via a PEP nebulizer. We measured the number of days the patients required intravenous antibiotics from enrollment to study end, compared to an equal period before PEP, and the mean time between the patients' 3 most recent infective pulmonary exacerbation episodes before PEP to their next exacerbation after PEP. Patients also completed a Likert-scale adverse-effects questionnaire on hypertonic saline via PEP versus jet nebulizer.
  
  
  RESULTS
  The 4 patients had severe CF pulmonary disease and all fully tolerated hypertonic saline via PEP, for 77, 92, 128, and 137 days, respectively until the study end date. There were fewer days of antibiotics in 3 of the 4 patients, from 45 to 20 days, 66 to 14 days, and 28 to 0 days (mean relative risk reduction 53%, P = .11). The other patient had 63 days of antibiotics during both the PEP and the jet nebulizer periods. There was a mean 3.6-fold longer time to next infective pulmonary exacerbation during the PEP period (P = .07). Adverse effects were less with PEP: chest tightness 68% (P = .04), bad taste 62% (P = .06), cough 47% (P = .10), and sore throat 50% (P = .20).
  
  
  CONCLUSIONS
  Hypertonic saline via PEP nebulizer benefits CF patients who do not tolerate hypertonic saline via jet nebulizer.
authors.affiliation: Cork Adult Cystic Fibrosis Centre, Department of Respiratory Medicine, Cork University Hospital, University College Cork, Wilton, Cork, Ireland.
authors.forename: Oisin J
authors.initials: OJ
authors.lastname: O'Connell
authors.forename: Carmel
authors.initials: C
authors.lastname: O'Farrell
authors.forename: Mike J
authors.initials: MJ
authors.lastname: Harrison
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Eustace
authors.forename: Michael T
authors.initials: MT
authors.lastname: Henry
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Plant
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000008:administration & dosage; D003550:Cystic Fibrosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D009330:Nebulizers and Vaporizers; D012129:Respiratory Function Tests; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents; D012462:Saline Solution, Hypertonic; D000420:Albuterol