Inhaled hypertonic saline (HS) as adjunctive therapy for airway clearance in cystic fibrosis (CF) improves overall lung function, notably the FEV1. Less well studied is its role in decreasing the number of clinical exacerbations. We aim to study the efficacy of inhaled HS in decreasing the frequency of pulmonary exacerbations in CF lung disease, and also assess the impact of demographic and clinical variables on its therapeutic effect.
We retrospectively reviewed a cohort of patients over the last 3 years at an accredited academic CF care center using the Port CF© database. All patients were using nebulized dornase alpha and an oscillatory compression device for mucociliary clearance. Episodes of pulmonary exacerbations and utilization of inhaled HS were identified. Using Chi-Square testing, the Mantel-Haenszel odds ratio was calculated to assess the likelihood of pulmonary exacerbations when using HS. Univariate analysis using independent t-testing as well as logistic regression were performed to measure the coexistent effects of age, gender, body mass index(BMI) and FEV1% predicted.
We identified 340 clinical care episodes, with a median patient age of 26±11 years; 65% were male. 276 episodes were due to pulmonary exacerbations; 62 episodes were in patients using inhaled HS. The odds ratio of developing a pulmonary exacerbation when using HS was 0.27 (C.I. 0.14–0.49, p<0.001). The number needed to treat (NNT) to prevent one clinical exacerbation was 5. Patients with higher FEV1% predicted (Mean FEV1% 74±4 vs. 66±12, p=0.003) and lower BMI (Mean BMI 24±6 vs. 30±9, p=0.006) responded better to HS, while age and gender had no significant correlation.
In our study, inhaled HS significantly decreased the number of pulmonary exacerbations. Patients with milder lung disease demonstrated a better therapeutic response to HS as opposed to those with more severe lung disease. Patients with a lower BMI also showed greater benefit.
Inhaled HS remains a valuable adjunctive therapy to decrease the number of pulmonary exacerbations in CF lung disease, especially in patients with lower severity of lung disease.
Dayton Dmello, No Financial Disclosure Information; No Product/Research Disclosure Information