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Cystic fibrosis
Timing of hypertonic saline and airway clearance techniques in adults with cystic fibrosis during pulmonary exacerbation: pilot data from a randomised crossover study
  1. Katherine O'Neill1,
  2. Fidelma Moran2,
  3. Michael M Tunney3,
  4. J Stuart Elborn1,
  5. Ian Bradbury4,
  6. Damian G Downey5,
  7. Jackie Rendall5 and
  8. Judy M Bradley6
  1. 1Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
  2. 2School of Health Sciences, Ulster University, Jordanstown, UK
  3. 3School of Pharmacy, Queen's University Belfast, Belfast, UK
  4. 4Frontier Science (Scotland) Ltd, Scotland, UK
  5. 5Belfast Health and Social Care Trust, Belfast, UK
  6. 6Clinical Research Facility, Queen's University Belfast, Belfast, UK
  1. Correspondence to Dr Katherine O'Neill; k.oneill{at}qub.ac.uk

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.

Objectives 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.

Trial registration number NCT01753869; Pre-results.

  • Cystic Fibrosis
  • Respiratory Measurement

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjresp-2016-000168

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    Footnotes

    • Contributors KO'N, FM, MMT, JSE and JMB conceived and designed research; KO'N, FM and JMB recruited patients, performed treatment, collected clinical data and performed the assessments; KO'N, FM, MMT, IB, JSE and JMB analysed data; DGD and JR provided intellectual contributions; KO'N, FM, JMB, MMT and JSE wrote the paper.

    • Funding This work was supported by Forest Laboratories Europe.

    • Competing interests None declared.

    • Ethics approval This study was approved by the Office for Research Ethics Committees Northern Ireland (REC reference number 12/NI/0153).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.