Does nebulized hypertonic saline improve outcomes in patients with cystic fibrosis? A systematic review and recent guidelines

Systematic review of evidence on nebulised saline

Wark P, McDonald VM. Nebulised hypertonic saline for cystic fibrosis. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD001506.

Objective: To investigate the effects of nebulised HS in CF compared to placebo or other treatments for mucociliary clearance.

Author’s conclusions : no long term effect on lung function; some affect on pulmonary exacerbations

Inclusion: Controlled trials compared hypertonic saline to placebo or other mucolytic therapy, for any duration or dose regimen in people with CF (any age or disease severity).


1 double-blind, trial (n=164) with concealed allocation, comparing 7% saline to isotonic saline with intention-to-treat analysis and 10% lost to follow up

1 unblinded trial comparing 6% saline to isotonic saline for 2 weeks duration.

Both trials measured change in FEV1 and FVC, quality of life, and number of pulmonary exacerbations.

Average number of visits for pulmonary exacerbations decreased with use of hypertonic saline.

Summary of percent change in FEV1 and summary of percent change in FVC at 2-4, 12, 24, 36, and 48 weeks : statistically significant favoring hypertonic saline at 4 weeks; effect decreases over time; no significant difference at 48 weeks.

Reported change in quality of life for hypertonic saline versus isotonic saline: CFQ, CFQ Parent, SF36. Significant change reported in CFQ.

Guidelines from the Cystic Fibrosis Foundation

Flume PA, Cystic Fibrosis Foundation, Pulmonary Therapies Committee, et al. Cystic fibrosis pulmonary guidelines: chronic medications for maintenance of lung health. Am J Respir Crit Care Med. 2007; 176(10):957-69.

See Hypertonic Saline section for discussion and recommendations. The guidelines consider the results of the same two trials as were reviewed above and determines that hypertonic saline provides a moderate benefit.

Additional evidence on management of cystic fibrosis

For a summary of evidence on various therapies, read the therapy section of the Dynamed Plus entry for cystic fibrosis

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Clinical Informationist at EUH Branch Library
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