title: Timing of hypertonic saline and airway clearance techniques in adults with cystic fibrosis during pulmonary exacerbation: pilot data from a randomised crossover study.
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.
  
  
  OBJECTIVE
  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.
  
  
  BACKGROUND
  NCT01753869; Pre-results.
authors.affiliation: Centre for Experimental Medicine, Queen's University Belfast , Belfast , UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: O'Neill
authors.affiliation: School of Health Sciences, Ulster University , Jordanstown , UK.
authors.forename: Fidelma
authors.initials: F
authors.lastname: Moran
authors.affiliation: School of Pharmacy, Queen's University Belfast , Belfast , UK.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Tunney
authors.affiliation: Centre for Experimental Medicine, Queen's University Belfast , Belfast , UK.
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Elborn
authors.affiliation: Frontier Science (Scotland) Ltd , Scotland , UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Bradbury
authors.affiliation: Belfast Health and Social Care Trust , Belfast , UK.
authors.forename: Damian G
authors.initials: DG
authors.lastname: Downey
authors.affiliation: Belfast Health and Social Care Trust , Belfast , UK.
authors.forename: Jackie
authors.initials: J
authors.lastname: Rendall
authors.affiliation: Clinical Research Facility, Queen's University Belfast , Belfast , UK.
authors.forename: Judy M
authors.initials: JM
authors.lastname: Bradley
keywords: Cystic Fibrosis; Respiratory Measurement