Adults with cystic fibrosis prefer hypertonic saline before or during airway clearance techniques: a randomised crossover trial

Abbott, 2004, Adherence with the use of clearance techniques, 188, 105 1995, Standardization of spirometry: 1994 Update, American Journal of Respiratory & Critical Care Medicine, 152, 1107, 10.1164/ajrccm.152.3.7663792 App, 1998, Sputum rheology changes in cystic fibrosis lung disease following two different types of physiotherapy: flutter vs autogenic drainage, Chest, 114, 171, 10.1378/chest.114.1.171 Behrends, 2010, Metabolic profiling of Pseudomonas aeruginosa demonstrates that the anti-sigma factor MucA modulates osmotic stress tolerance, Molecular Biosystems, 6, 562, 10.1039/b918710c Bell, 2011, Cystic fibrosis in Australia, 2009: results from a data registry, Medical Journal of Australia, 195, 396, 10.5694/mja11.10719 Bishop, 2011, Timing of dornase alpha inhalation does not affect the efficacy of an airway clearance regimen in adults with cystic fibrosis: a randomised crossover trial, Journal of Physiotherapy, 57, 223, 10.1016/S1836-9553(11)70052-2 Boucher, 2007, Evidence for airway surface dehydration as the initiating event in CF airway disease, Journal of Internal Medicine, 261, 5, 10.1111/j.1365-2796.2006.01744.x Bye, 2007, Other mucoactive agents for cystic fibrosis, Paediatric Respiratory Reviews, 8, 30, 10.1016/j.prrv.2007.02.008 Dasgupta, 1998, Effects of sputum oscillations and rhDNase in vitro: a combined approach to treat cystic fibrosis lung disease, Pediatric Pulmonology, 26, 250, 10.1002/(SICI)1099-0496(199810)26:4<250::AID-PPUL3>3.0.CO;2-X Dasgupta, 1995, Effects of combined treatment with rhDNase and airflow oscillations on spinnability of cystic fibrosis sputum in vitro, Pediatric Pulmonology, 20, 78, 10.1002/ppul.1950200205 Dentice R, Elkins M (2011) Timing of dornase alfa inhalation for cystic fibrosis. Cochrane Database of Systematic Reviews Issue 5. Art. No.: CD007923. DOI: 10.1002/14651858. CD007923.pub2. Dentice R, Elkins M, Soni R, Bye P (2006) Patient satisfaction with physiotherapy techniques for airway clearance in cystic fibrosis. Journal of Cystic Fibrosis 5: S81 A365. Donaldson, 2006, Mucus clearance and lung function in cystic fibrosis with hypertonic saline, New England Journal of Medicine, 354, 241, 10.1056/NEJMoa043891 Dwyer, 2011, The role of exercise in maintaining health in cystic fibrosis, Current Opinion in Pulmonary Medicine, 6, 455, 10.1097/MCP.0b013e32834b6af4 Elkins, 2006, Inhaled hypertonic saline as a therapy for cystic fibrosis, Current Opinion in Pulmonary Medicine, 12, 445, 10.1097/01.mcp.0000245714.89632.b2 Elkins MR, Jones A, van der Schans C (2006a) Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis. Cochrane Database of Systematic Reviews Issue 2. Art. No.: CD003147. DOI: 10.1002/14651858.CD003147.pub3. Elkins MR, Dentice RL (2010) Timing of hypertonic saline inhalation for cystic fibrosis. Cochrane Database of Systematic Reviews Issue 11. Art. No.: CD008816. DOI: 10.1002/14651858.CD008816. Elkins, 2006, ) A controlled trial of long-term inhaled hypertonic saline in patients with cystic fibrosis, New England Journal of Medicine, 354, 229, 10.1056/NEJMoa043900 Goralski, 2010, Osmolytes and ion transport modulators: new strategies for airway surface rehydration, Current Opinion in Pharmacology, 10, 294, 10.1016/j.coph.2010.04.003 King, 1997, Rheology of cystic fibrosis sputum after in vitro treatment with hypertonic saline alone and in combination with recombinant human deoxyribonuclease I, American Journal of Respiratory & Critical Care Medicine, 156, 173, 10.1164/ajrccm.156.1.9512074 Knudson, 1983, Changes in the normal maximal expiratory flow-volume curve with growth and aging, American Review of Respiratory Disease, 127, 725 Kuys, 2011, Gaming console exercise and cycle or treadmill exercise provide similar cardiovascular demand in adults with cystic fibrosis: a randomised cross-over trial, Journal of Physiotherapy, 57, 35, 10.1016/S1836-9553(11)70005-4 Laube, 2005, Positive expiratory pressure changes aerosol distribution in patients with cystic fibrosis, Respiratory Care, 50, 1438 Main E, Prasad A, van der Schans CP (2009) Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis. Cochrane Database of Systematic Reviews Issue 1. Art. No.: CD002011. DOI: 10.1002/14651858.CD002011.pub2. McIlwaine MP, Van Ginderdeuren F (2009) Physiotherapy for people with Cystic Fibrosis: from infant to adult (4th ed). International Physiotherapy Group for Cystic Fibrosis. www.cfww.org/ipg-cf/ Pryor, 2008, Physiotherapy Techniques (Ch 5) Robinson, 1997, Effect of increasing doses of hypertonic saline on mucociliary clearance in patients with cystic fibrosis, Thorax, 52, 900, 10.1136/thx.52.10.900 Robinson, 1996, Effect of hypertonic saline, amiloride, and cough on mucociliary clearance in patients with cystic fibrosis, American Journal of Respiratory & Critical Care Medicine, 153, 1503, 10.1164/ajrccm.153.5.8630593 van der Schans C, Prasad A, Main E (2005) Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis. Cochrane Database of Systematic Reviews Issue 2. Art. No.: CD001401. DOI: 10.1002/14651858.CD001401. Wark PAB, McDonald V (2009) Nebulised hypertonic saline for cystic fibrosis (Cochrane Review). Cochrane Database of Systematic Reviews Issue 2. Art. No.: CD001506. DOI: 10.1002/14651858.CD001506.pub3. Williams, 2010, Hypertonic saline therapy in cystic fibrosis: do population shifts caused by the osmotic sensitivity of infecting bacteria explain the effectiveness of this treatment?, Microbiology, 1, 120 Wills, 1997, Sodium chloride increases the ciliary transportability of cystic fibrosis and bronchiectasis sputum on the mucus-depleted bovine trachea, Journal of Clinical Investigation, 99, 9, 10.1172/JCI119138