title: A randomised trial of hypertonic saline during hospitalisation for exacerbation of cystic fibrosis.
abstract: BACKGROUND
  The mucoactive effects of hypertonic saline should promote exacerbation resolution in people with cystic fibrosis (CF).
  
  
  OBJECTIVE
  To determine the effects of hypertonic saline inhalation during hospitalisation for exacerbation of CF on length of stay, lung function, symptoms, oxygenation, exercise tolerance, quality of life, bacterial load and time to next hospitalisation.
  
  
  METHODS
  132 adults with an exacerbation of CF were randomised to inhale three nebulised doses a day of either 4 mL 7% saline or a taste-masked control of 0.12% saline, throughout the hospital admission. The primary outcome measure was length of hospital stay.
  
  
  RESULTS
  All participants tolerated their allocated saline solution. There was no significant difference in length of stay, which was 12 days in the hypertonic saline group and 13 days in controls, with a mean between-group difference (MD) of 1 day (95% CI 0 to 2). The likelihood of regaining pre-exacerbation FEV1 by discharge was significantly higher in the hypertonic saline group (75% vs 57%), and the number needed to treat was 6 (95% CI 3 to 65). On a 0-100 scale, the hypertonic saline group had significantly greater reduction in symptom severity than the control group at discharge in sleep (MD=13, 95% CI 4 to 23), congestion (MD=10, 95% CI 3 to 18) and dyspnoea (MD=8, 95% CI 1 to 16). No significant difference in time to next hospitalisation for a pulmonary exacerbation was detected between groups (HR=0.86 (CI 0.57 to 1.30), p=0.13). Other outcomes did not significantly differ.
  
  
  CONCLUSIONS
  Addition of hypertonic saline to the management of a CF exacerbation did not reduce the length of hospital stay. Hypertonic saline speeds the resolution of exacerbation symptoms and allows patients to leave hospital with greater symptom resolution.
  
  
  BACKGROUND
  ACTRN12605000780651.
authors.affiliation: Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Ruth L
authors.identifier: http://orcid.org/0000-0002-6745-7932
authors.initials: RL
authors.lastname: Dentice
authors.affiliation: Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Elkins
authors.affiliation: Ludwig Engel Centre for Respiratory Research, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Middleton
authors.affiliation: Ludwig Engel Centre for Respiratory Research, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Bishop
authors.affiliation: Centre for Asthma and Respiratory Diseases, Hunter Medical Research Institute, University of Newcastle and John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Peter A B
authors.initials: PA
authors.lastname: Wark
authors.affiliation: Centre for Asthma and Respiratory Diseases, Hunter Medical Research Institute, University of Newcastle and John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Dorahy
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Harmer
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Honghua
authors.initials: H
authors.lastname: Hu
authors.affiliation: Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Peter T P
authors.initials: PT
authors.lastname: Bye
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D003550:Cystic Fibrosis / Q000188:drug therapy* / Q000503:physiopathology; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects / Q000502:physiology; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D011788:Quality of Life; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D012462:Saline Solution, Hypertonic
keywords: Cystic Fibrosis; Nebuliser therapy; Respiratory Infection