Inhaled hypertonic saline increases sputum expectoration in cystic fibrosis

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Abstract
To determine whether inhalation of hypertonic saline (HS) increases sputum expectoration in patients with cystic fibrosis (CF). Ten adolescents with CF, who were receiving inpatient treatment for a pulmonary exacerbation, were enrolled in a controlled cross-over clinical trial. After inhalation of beta adrenergic drug to prevent possible broncho-constriction, each patient inhaled for 10 min either 0.9% isotonic saline (IS) or 6% HS prior to routine physiotherapy. The following day the patient received the alternative solution. Seven patients undertook a second block after 1-5 days. Outcome measures included weight of sputum, a visual analogue score to assess the subjective feeling of a cleared chest after physiotherapy, and spirometry. Sputum expectoration (median; Q1,Q3) from the beginning of the inhalation of HS or IS to the final spirometry measure 60 min post-physiotherapy was significantly greater after HS than IS [17.2g (11.7, 34.8) vs 11.3g (6.5, 16.1): P = 0.006]. A clinical score of the patient's own judgement of a cleared chest was significantly better after HS than IS. Spirometry results did not change following either of the two inhalations. These data show that the inhalation of 6% HS prior to physiotherapy can increase sputum expectoration in patients with CF and suggest that HS might be an effective, safe and cheap adjunct to regular physiotherapy in patients with CF.