Timing of hypertonic saline inhalation for cystic fibrosis

Mark Elkins; Ruth Dentice

doi:10.1002/14651858.CD008816.pub3

Momento adecuado para la inhalación de solución salina hipertónica en la fibrosis quística

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Dentice R, Elkins M, Bye P. Hypertonic saline before vs during vs after physiotherapy techniques for airway clearance in people with cystic fibrosis: A randomised trial [abstract]. Physiotherapy (United Kingdom) 2011;97:eS308‐eS309, Abstract no: RR‐PL‐3136. [CENTRAL: 1089301; CRS: 5500050000000300; EMBASE: 71882596]

Google Scholar

Dentice R, Elkins MR, Bye PT. A randomised trial of the effect of timing of hypertonic saline inhalation in relation to airway clearance physiotherapy in adults with cystic fibrosis [abstract]. Pediatric Pulmonology 2010;Suppl 33:384.

Google Scholar

Dentice RL, Elkins MR, Bye PT. Adults with cystic fibrosis prefer hypertonic saline before or during airway clearance techniques: a randomised crossover trial. Journal of Physiotherapy 2012;58(1):33‐40. []

Dentice RL, Elkins MR, Bye PT. Online Supplementary Material ‐ Table 3 : Individual outcome data to "Adults with cystic fibrosis prefer hypertonic saline before or during airway clearance techniques: a randomised crossover trial" [online]. Journal of Physiotherapy 2012;58(1):33‐40 Online. []

Van Ginderdeuren F, Vanlaethem S, Eyns H, De Schutter I, Dewachter E, Malfroot A. Influence of inhaled hypertonic saline (NaCI 6%) before or during autogenic drainage on sputum weight, oxygen saturation, heart frequency and dysponoea in cystic fibrosis [abstract]. Journal of Cystic Fibrosis 2011;10 Suppl 1:S62. []

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Adde FV, Borges KTL, Hatanaka ACF, Nakaie CMA, Cardieri JMA, Oliveira RC, et al. Hypertonic saline X recombinant human DNase: a randomised crossover study in 18 cystic fibrosis patients [abstract]. Journal of Cystic Fibrosis 2004;4(Suppl 1):S66.

Google Scholar

Amin R, Subbarao P, Jabar A, Balkovec S, Jensen R, Kerrigan S, et al. Hypertonic saline improves the LCI in paediatric patients with CF with normal lung function. Thorax 2010;65(5):379‐83.

Amin R, Subbarao P, Jabar A, Balkovec S, Jensen R, Kerrigan S, et al. Inhaled hypertonic saline (7%) improves LCI in paediatric CF patients with normal lung function [abstract]. Pediatric Pulmonology 2009;44(Suppl 32):289, Abstract no: 223.

Google Scholar

Amin R, Stanojevic S, Kane M, Webster H, Ratjen F. A randomized controlled trial to evaluate the lung clearance index as an outcome measure for early phase studies in patients with cystic fibrosis. Respiratory Medicine 2016;112:59‐64. [CRS: 5500135000001524; PUBMED: 26856191]

Aquino ES, Shimura F, Santos AS, Goto DM, Coelho CC, de Fuccio MB, et al. CPAP has no effect on clearance, sputum properties, or expectorated volume in cystic fibrosis. Respiratory Care 2012;57(11):1914‐9. [; JID:: 7510357]

Balinotti J, Rodriguez V, Zaragoza S, Lubovich S, Kofman C, Garcia Bournissen F. Effect of early intervention with inhaled hypertonic saline on lung function in infants and toddlers with cystic fibrosis diagnosed by neonatal screening [abstract]. American Journal of Respiratory and Critical Care Medicine 2015;191(Meeting Abstracts):A3342. [CENTRAL: 1127230; CRS: 5500050000000303]

Google Scholar

Ballmann M, von der Hardt H. Hypertonic saline and recombinant human DNase: a randomised cross‐over pilot study in patients with cystic fibrosis [abstract]. 22nd European Cystic Fibrosis Conference; 1998 June 13‐19; Berlin, Germany. 1998:80.

Google Scholar

Ballmann M, von der Hardt H. Hyptertonic saline and recombinant human DNase: a randomised cross‐over pilot study in patients with cystic fibrosis. Journal of Cystic Fibrosis 2002;1(1):35‐7.

Brivio A, Ceruti C, Gambazza S, Colombo C. Randomized double‐blind monocentric trial on tolerability, acceptability and efficacy of two formulations of inhaled 7% hypertonic saline with and without hyaluronic acid in reducing airways inflammation in patients with cystic fibrosis ‐ Preliminary results. Journal of Cystic Fibrosis 2013;12(Suppl 1):S104.

Google Scholar

Brivio A, Conese M, Gambazza S, Biffi A, Tirelli AS, Russo M, et al. Pilot Randomized Controlled Trial Evaluating the Effect of Hypertonic Saline With and Without Hyaluronic Acid in Reducing Inflammation in Cystic Fibrosis. Journal of Aerosol Medicine and Pulmonary Drug Delivery 2016;29(6):482‐9. [CENTRAL: 1155400; CRS: 5500135000001523; PUBMED: 27149365]

Brown AW, Laube BL, Zeman K, Lechtzin N, Sharpless G, Wu J, et al. Durability of hypertonic saline for enhancing mucociliary clearance in cystic fibrosis [abstract]. Pediatric Pulmonology 2010;45 Suppl 33:303, Abstract no: 237. []

Google Scholar

Buonpensiero P, De Gregorio F, Sepe A, Di Pasqua A, Ferri P, Siano M, et al. Hyaluronic acid improves "pleasantness" and tolerability of nebulized hypertonic saline in a cohort of patients with cystic fibrosis. Advances in Therapy 2010;27(11):870‐8.

Buonpensiero P, De Gregorio F, Sepe A, Di Pasqua A, Ferri P, Siano M, et al. Hyaluronic acid improves tolerability of hypertonic saline in CF patients [abstract]. Journal of Cytsic Fibrosis 2010;9(Suppl 1):S63.

Google Scholar

Buonpensiero P, De Gregorio F, Sepe A, Di Pasqua A, Ferri P, Siano M, et al. Inhaled hyaluronic acid improves pleasantness and tolerability of nebulised hypertonic saline in patients with cystic fibrosis [abstract]. Pediatric Pulmonology 2009;44(Suppl 32):243.

Google Scholar

Cardinale F, Manca A, Mappa L, Tesse R, Cavallone R, Loffredo MS, et al. Effects on exhaled nitric oxide levels and lung function of ultrasonically nebulized hypertonic solution in cystic fibrosis [abstract]. European Respiratory Journal 2003;22(Suppl 45):231s.

Google Scholar

Chadwick SL, Moss SJ, Bott J, Geddes DM, Alton EWFW. Effect of hypertonic saline, isotonic saline and water challenges on the airways of cystic fibrosis patients [abstract]. Thorax 1997;52(Suppl 6):A43.

Google Scholar

De Cono N, Schelstraete P, Haerynck F, Van daele S, Sanders N, De Baets F. Hypertonic saline: effect on mucus rheology and spirometry [abstract]. Journal of Cystic Fibrosis 2008;7(Suppl 2):S24.

Google Scholar

Dentice R, Elkins M, Bye P. A randomised controlled trial of hypertonic saline inhalation to enhance airway clearance physiotherapy in adults hospitalised with Cystic Fibrosis (CF) [abstract]. Physiotherapy (United Kingdom) 2015;101:eS356. [CENTRAL: 1126510; CRS: 5500050000000302; EMBASE: 72114064]

Dentice R, Elkins M, Bye P. A randomised trial of hypertonic saline nebulisation during hospitalisation for pulmonary exacerbation in adults with cystic fibrosis [abstract]. Pediatric Pulmonology 2012;47 Suppl:257‐8, Abstract no: 102. [CENTRAL: 1030604; CRS: 5500050000000301; EMBASE: 70891850]

Google Scholar

Dentice R, Elkins M, Middleton P, Bishop J, Wark P, Dorahy D, et al. A randomised controlled trial of the effect of hypertonic saline (HS) inhalation on exacerbation resolution, hospital length of stay and time to relapse in adults with cystic fibrosis [abstract]. Journal of Cystic Fibrosis 2013;12 Suppl 1:S38, Abstract no: WS19.4. []

Dentice RL, Elkins MR, Middleton PG, Bishop JR, Wark PAB, Dorahy DJ, et al. A randomised trial of hypertonic saline during hospitalisation for exacerbation of cystic fibrosis. Thorax 2016;71(2):141‐7. [CENTRAL: 1138352; CRS: 5500050000000401; EMBASE: 20160158105]

Donaldson SH, Bennett W, Zeman K, Knowles MR, Boucher RC. Efficacy of amiloride and hypertonic saline in cystic fibrosis [abstract]. Pediatric Pulmonology 2003;Suppl 25:251.

Google Scholar

Donaldson SH, Bennett W, Zeman K, Knowles MR, Boucher RC. Efficacy of amiloride and hypertonic saline in cystic fibrosis. Pediatric Pulmonology 2003;Suppl 25:251.

Google Scholar

Donaldson SH, Bennett WD, Zeman KL, Knowles MR, Tarran R, Boucher RC. Mucus clearance and lung function in cystic fibrosis with hypertonic saline. New England Journal of Medicine 2006;354(3):241‐50.

Donaldson SH, Bennett WD, Zeman KL, Knowles MR, Tarran R, Boucher RC. Online Supplement to 'Mucus clearance and lung function in cystic fibrosis with hypertonic saline' [online]. New England Journal of Medicine2006; Vol. 354, issue 3:241‐50.

Google Scholar

Donaldson SH, Samulski D, LaFave C, Wu J, Zeman K, Salazar C, Bennett WD, Davis SD. Sustained effect of hypertonic saline on mucociliary clearance in CF children with mild lung disease. Pediatric Pulmonology 2013;48(Suppl 36):210.

Google Scholar

Dwyer T, Elkins M, Dentice R, Forbes S, McArthur M, Cooper P, et al. Saline at a lower tonicity in cystic fibrosis (SALTI‐CF) trial ‐ a randomised, controlled trial comparing 0.9% v 3% v 6% nebulised saline [abstract]. Journal of Cystic Fibrosis 2013;12 Suppl 1:S19, Abstract no: WS9.5. []

Bye P, Elkins M, Robinson M, Moriarty C, Rose B, Harbour C, et al. Long‐term inhalation of hypertonic saline in patients with cystic fibrosis‐ a randomised controlled trial [abstract]. Pediatric Pulmonology 2004;38(Suppl 27):329.

Elkins M, Robinson M, Moriarty C, Sercombe J, Rose B, Harbour C, et al. Three methods of monitoring adherence in a long‐term trial in Cystic Fibrosis [abstract]. Journal of Cystic Fibrosis 2006;5(Suppl 1):S111, Abstract no: 504.

Google Scholar

Elkins MR, Robinson M, Moriarty C, Sercombe J, Rose B, Harbour C. Three methods of monitoring adherence in the national hypertonic saline trial in cystic fibrosis [abstract]. Pediatric Pulmonology 2005;40(Suppl 28):268.

Google Scholar

Elkins MR, Robinson M, Rose BR, Harbour C, Moriarty CP, Marks GB, et al. A controlled trial of long‐term inhaled hypertonic saline in patients with cystic fibrosis. New England Journal of Medicine 2006;354(3):229‐40.

Ratjen F. Inhaled hypertonic saline produces small increases in lung function in patients with cystic fibrosis. Journal of Pediatrics 2006;149(1):142. [CENTRAL: 1253122; CRS: 5500135000001675; PUBMED: 17243308]

Elkins MR, Tingpej P, Moriarty CP, Yozghatlian V, Rose BR, Harbour C, et al. Tolerability of hypertonic saline when delivered rapidly via the Eflow® rapid nebulizer in subjects with cystic fibrosis [abstract]. Pediatric Pulmonlogy 2006;41(Suppl 29):292.

Google Scholar

Button BM, Riedler J, Reade T, Eng P, Robertson CF. Inhaled hypertonic saline as an adjunct to chest physiotherapy in cystic fibrosis: The three‐year clinical experience [abstract]. Pediatric Pulmonology 1996;22(Suppl 13):306.

Google Scholar

Eng P, Morton J, Douglass J, Riedler J, Wilson J, Robertson CF. Efficacy of short‐term ultrasonically nebulised hypertonic saline in patients with cystic fibrosis [abstract]. European Respiratory Journal 1995;8(Suppl 19):510s.

Google Scholar

Eng P, Morton J, Douglass J, Riedler J, Wilson J, Robertson CF. Short‐term administration of ultrasonically nebulised hypertonic saline improves pulmonary function in patients with cystic fibrosis [abstract]. Australian and New Zealand Journal of Medicine 1995;25:440.

Google Scholar

Eng PA, Morton J, Douglass JA, Riedler J, Wilson J, Robertson CF. Short‐term efficacy of ultrasonically nebulized hypertonic saline in cystic fibrosis. Pediatric Pulmonology 1996;21(2):77‐83. [MEDLINE: 97036562]

Furnari ML, Termini L, Traverso G, Barrale S, Bonaccorso MR, Damiani G, et al. Nebulized hypertonic saline containing hyaluronic acid improves tolerability in patients with cystic fibrosis and lung disease compared with nebulized hypertonic saline alone: a prospective, randomized, double‐blind, controlled study. Therapeutic Advances in Respiratory Disease 2012;6(6):315‐22. []

Grasemann H, Kurtz F, Ratjen F. Inhalation of nebulized L‐Arginine increases exhaled nitric oxide and improves pulmonary function in patients with cystic fibrosis [abstract]. Pediatric Pulmonology 2005;40 Suppl 28:308. []

Google Scholar

Grasemann H, Tullis E, Ratjen F. A randomized controlled trial of inhaled l‐Arginine in patients with cystic fibrosis. Journal of Cystic Fibrosis 2013;12(5):468‐74. []

Grasemann H, Tullis E, Ratjen F. A randomized placebo controlled study on the effects of L‐arginine inhalation in patients with cystic fibrosis [abstract]. Pediatric Pulmonology 2011;46 Suppl 34:293, Abstract no: 229. [CENTRAL: 921615; CRS: 5500125000000391]

Google Scholar

Grasemann H, Tullis E, Ratjen F. Inhaled L‐arginine in patients with cystic fibrosis ‐ a randomized controlled trial [abstract]. Journal of Cystic Fibrosis 2011;10 Suppl 1:S21, Abstract no: 81. []

Google Scholar

Grieve R, Thompson S, Normand C, Suri R, Bush A, Wallis C. A cost‐effectiveness analysis of rhDNase in children with cystic fibrosis. International Journal of Technology Assessment in Health Care 2003;19(1):71‐9.

Gupta S, Ahmed F, Lodha R, Gupta YK, Kabra SK. Comparison of effects of 3 and 7% hypertonic saline nebulization on lung function in children with cystic fibrosis: a double‐blind randomized, controlled trial. Journal of Tropical Pediatrics 2012;58(5):375‐81. []

Herrero Cortina B, San Miguel Pagola M, Cebria i Ranzo MA, Gomez Romero M, Diaz Gutierrez F, Reychler G. Short‐term effects of hypertonic saline nebulization combined with oscillatory positive expiratory pressure in cystic fibrosis: randomised crossover trial [abstract]. Journal of Cystic Fibrosis 2016;15 Suppl 1:S33, Abstract no: WS21.3. [CENTRAL: 1155402; CRS: 5500135000001528]

Google Scholar

Hofmann T, Senier I, Ziersch A, Geidel C, Regnis J, Lindemann H. Additive effect of amiloride and hypertonic saline on respiratory ion transport cystic fibrosis [abstract]. Proceedings of the 21st European Cystic Fibrosis Conference; 1997; Davos, Switzerland. 1997:119.

Google Scholar

Homola L, Holèikova A, Mikolasek P, Krbkova L. Efficacy of inhaled amiloride solution versus hypertonic saline, prospective open label single center study in children with cystic fibrosis [abstract]. Journal of Cystic Fibrosis 2013;12 Suppl 1:S98, Abstract no: 195. []

Google Scholar

Kobylyansky VI, Gembitskaya TE. Study of the mucociliary and cough clearance in patients with mucoviscidosis and evaluation of hypertonic sodium chorlide solution influence on them [abstract]. European Respiratory Journal 2000;16(Suppl 31):121S.

Google Scholar

Laube BI, Sharpless GJ, Kelly AE, Mogayzel PJ. Effect of hypertonic saline on mucociliary clearance in children with cystic fibrosis [abstract]. Pediatric Pulmonology 2009;44 Suppl 32:238, Abstract no: 77.

Google Scholar

Laube BL, Sharpless G, Carson KA, Kelly A, Mogayzel PJ. Acute inhalation of hypertonic saline does not improve mucociliary clearance in all children with cystic fibrosis. BMC Pulmonary Medicine 2011;11:45. [CENTRAL: 806034; CRS: 5500050000000304; PUBMED: 21896198]

Mainz JG, Schaedlich K, Hentschel J, Schumacher U, Koitschev C, Koitschev A, et al. Sinonasal inhalation of isotonic vs. hypertonic saline (6.0%) in CF patients with chronic rhinosinusitis ‐ results of a multicentre, double‐blind, controlled prospective trial [abstract]. Journal of Cystic Fibrosis 2015;14 Suppl 1:S95, Abstract no: 146. [CENTRAL: 1081480; CRG ID: CO59a; CRS: 5500135000000026]

Mainz JG, Schumacher U, Schadlich K, Hentschel J, Koitschev C, Koitschev A, et al. Sino nasal inhalation of isotonic versus hypertonic saline (6.0%) in CF patients with chronic rhinosinusitis ‐ Results of a multicenter, prospective, randomized, double‐blind, controlled trial. Journal of Cystic Fibrosis : Official Journal of the European Cystic Fibrosis Society 2016;15(6):e57‐66. [CENTRAL: 1155399; CRG ID: CO59b; CRS: 5500135000001522; PUBMED: 27267518]

Palacio S, Guigno H, Diaz Casaux A, Lucero B, Smith S, Giorgetti M, Bonina A, Castanos C. Inhaled 7% hypertonic saline treatment in preschool children with cystic fibrosis. Journal of Cystic Fibrosis 2014;13(Suppl. 2):S7.

Button BM, Riedler J, Reade T, Eng P, Robertson CF. Inhlaed hypertonic saline as an adjunct to chest physiotherapy in cystic fibrosis; the three year clinical experience. Pediatric Pulmonology 1996;Suppl 13:306.

Google Scholar

Riedler J, Reade T, Button B, Robertson CF. A pilot study of inhaled hypertonic saline to increase sputum production in adolescents with cystic fibrosis [abstract]. European Respiratory Journal 1994;7 Suppl 18:430s.

Google Scholar

Riedler J, Reade T, Button B, Robertson CF. Inhaled hypertonic saline increases sputum expectoration in cystic fibrosis. Journal of Paediatrics and Child Health 1996;32(1):48‐50. [MEDLINE: 97036562]

Robinson M, Regnis JA, Bailey DL, King M, Bautovich GJ, Bye PT. Effect of hypertonic saline, amiloride, and cough on mucociliary clearance in patients with cystic fibrosis. American Journal of Respiratory and Critical Care Medicine 1996;153(5):1503‐9.

Robinson M, Hemming AL, Bailey DL, Mellis CM, Bautovich GJ, Bye PTP. Effect of increasing doses of hypertonic saline on mucociliary clearance in patients with cystic fibrosis [abstract]. American Journal of Respiratory and Critical Care Medicine 1996;154(Suppl):A70.

Google Scholar

Robinson M, Hemming AL, Regnis JA, Wong AG, Bailey DL, Bautovich GJ, et al. Effect of increasing doses of hypertonic saline on mucociliary clearance in patients with cystic fibrosis. Thorax 1997;52(10):900‐3. [MEDLINE: 98068190]

Robinson M, Parsons S, Hemming A, Bautovich G, Mellis CM, Bye PTP. Effect of increasing doses of hypertonic saline on mucociliary clearance in patients with cystic fibrosis [abstract]. Australian and New Zealand Journal of Medicine 1997;27:258.

Google Scholar

Robinson M, Daviskas E, Eberl S, Baker J, Anderson SD, Bye PT. Effect of inhaling a dry powder of mannitol on mucociliary clearance in adults with cystic fibrosis [abstract]. Pediatric Pulmonology 1998;Suppl 17:280. [MEDLINE: 97036562]

Google Scholar

Robinson M, Daviskas E, Eberl S, Baker J, Chan HK, Anderson SD, et al. The effect of inhaled mannitol on bronchial mucus clearance in cystic fibrosis patients: a pilot study. European Respiratory Journal 1999;14(3):678‐85.

Robinson M, Daviskas E, Eberl S, Baker J, Chan HK, Anderson SD, et al. The effect of inhaled mannitol on bronchial mucus clearance in cystic fibrosis patients: a pilot study [abstract]. Pediatric Pulmonology 2000;29(6):484.

Google Scholar

Ros M, Casciaro R, Lucca F, Alatri F, Salonini E, Favilli F, et al. Tolerability and acceptability in patients with cystic fibrosis (CF) of two formulations of 7% hypertonic saline: a prospective multicenter clinical study [abstract]. Pediatric Pulmonology 2012;47(S35):364, Abstract no: 390. []

Google Scholar

Alpern AN, Brumback LC, Ratjen F, Rosenfeld M, Davis SD, Quittner AL. Initial evaluation of the Parent Cystic Fibrosis Questionnaire‐‐Revised (CFQ‐R) in infants and young children. Journal of Cystic Fibrosis : Official Journal of the European Cystic Fibrosis Society 2015;14(3):403‐11. [CENTRAL: 1130846; CRG ID: CRG ; CRS: 5500135000001461; PUBMED: 25443473]

Brumback LC, Baines A, Ratjen F, Davis SD, Daniel SL, Quittner AL, et al. Pulmonary exacerbations and parent‐reported outcomes in children <6 years with cystic fibrosis. Pediatric Pulmonology 2015;50:236‐43. [CENTRAL: 1046755; CRG ID: BD175g; CRS: 5500131000000349; GR:: U01 HL092931/HL/NHLBI NIH HHS/United States; JID:: 8510590; PMCID:: PMC4213320; PUBMED: 24777957; U01: HL092932/HL/NHLBI NIH HHS/United States]

Davis SD, Ratjen F, Brumback LC, Johnson RC, Filbrun AG, Kerby GS, et al. Infant lung function tests as endpoints in the ISIS multicenter clinical trial in cystic fibrosis. Journal of Cystic Fibrosis : Official Journal of the European Cystic Fibrosis Society 2016;15(3):386‐91. [CRG ID: BD175l; CRS: 5500135000001676; PUBMED: 26547590]

Davis SD, Rosenfeld M, Brumback L, Donaldson S, Johnson R, Rowbotham R, et al. Infant PFTs as an endpoint in the infant study of inhaled saline randomized controlled trial [abstract]. Pediatric Pulmonology 2012;47(S35):302, Abstract no: 225. [; BD175d]

Google Scholar

Ratjen F, Rosenfeld M, Brumback L, Daniel S, Rowborham R. Efficacy of hypertonic saline in infants and young children: the ISIS study [abstract]. Journal of Cystic Fibrosis 2012;11 Suppl 1:S50, Abstract no: WS22.1. [CRG ID: BD175a; CRG ID: BD175a; ]

Ratjen F, Salazar J, Jensen R, Amin R, Gustafsson P, Stanojevic S, et al. Alternative multiple breath washout outcomes for clinical trials in cystic fibrosis [abstract]. European Respiratory Journal 2012;40 Suppl:Abstract no: 1261. [CENTRAL: 1100495; CRG ID: BD175j; CRS: 5500050000000311; EMBASE: 71925430]

Google Scholar

Rosenfeld M. Hypertonic saline should be the first drug used in CF [summary]. Pediatric Pulmonology 2013;48 Suppl 36:157, Summary: S12.3. [CENTRAL: 921667; CRS: 5500125000000393; BD175e]

Google Scholar

Rosenfeld M, Ratjen F, Brumback L, Daniel S, Rowbotham R, McNamara S, et al. Inhaled hypertonic saline in infants and children younger than 6 years with cystic fibrosis: the ISIS randomized controlled trial. JAMA 2012;307(21):2269‐77. [CRG ID: BD175b; CRG ID: BD175b; ]

Rosenfeld M, Ratjen F, Brumback L, Daniel S, Rowbotham R, McNamara S, et al. Online supplement to "Inhaled hypertonic saline in infants and children younger than 6 years with cystic fibrosis: the ISIS randomized controlled trial" [online]. JAMA 2012;307(21):2269‐77. [CENTRAL: 1155401; CRS: 5500135000001526; BD175k]

Rosenfeld M, Ratjen F, Brumback L, Kronmal R, Davis SD. Hypertonic saline in children with CF <6 years of age: Results of the ISIS trial [abstract]. Pediatric Pulmonology 2012;47:172. [CENTRAL: 1030608; CRG ID: BD175h; CRS: 5500050000000298; EMBASE: 70891711]

Subbarao P, Stanojevic S, Brown M, Jensen R, McDonald N, Gent K, et al. Effect of hypertonic saline on lung clearance index in infants and preschool children with CF: a pilot study [abstract]. Pediatric Pulmonology 2012;47(S35):301, Abstract no: 223. [CRG ID: BD175c; ]

Google Scholar

Subbarao P, Stanojevic S, Brown M, Jensen R, Rosenfeld M, Davis S, et al. Lung clearance index as an outcome measure for clinical trials in young children with cystic fibrosis. A pilot study using inhaled hypertonic saline. American Journal of Respiratory and Critical Care Medicine 2013;188(4):456‐60. [CENTRAL: 963541; CRG ID: BD15f; CRS: 5500127000000014; GR:: Canadian Institutes of Health Research/Canada; JID:: 9421642; OID: [Other ID]: NLM: PMC3778738; PMCID:: PMC3778738; PUBMED: 23742699; SI:: ClinicalTrials.gov/NCT00709280]

Ruiz de Valbuena Maiz M, Lamas A, Maiz L, Giron R, Barrio M, del Campo R, et al. Study of the efficacy of long‐term treatment with high volume compared to standard volume of hypertonic saline on pulmonary exacerbations in patients with cystic fibrosis [abstract]. Pediatric Pulmonology 2012;47(S35):360, Abstract no: 379. []

Google Scholar

Suri R, Grieve R, Normand C, Metcalfe C, Thompson S, Wallis C, et al. Effects of hypertonic saline, alternate day and daily rhDNase on healthcare use, costs and outcomes in children with cystic fibrosis. Thorax 2002;57(10):841‐6.

Suri R, Grieve R, Normand C, Metcalfe C, Thompson S, Wallis C, et al. Effects of hypertonic saline, alternate day and daily rhDNase on healthcare use, costs and outcomes in children with cystic fibrosis [abstract]. Thorax 2001;56(Suppl 3):iii84.

Google Scholar

Suri R, Marshall LJ, Wallis C, Metcalfe C, Bush A, Shute JK. Effects of recombinant human DNase and hypertonic saline on airway inflammation in children with cystic fibrosis. American Journal of Respiratory and Critical Care Medicine 2002;166(3):352‐5.

Suri R, Metcalfe C, Lees B, Flather M, Normand C, Thompson S, et al. A cross‐over comparative study of hypertonic saline alternate day and daily rhDNase in children with cystic fibrosis [abstract]. Thorax 2000;55:A75.

Google Scholar

Suri R, Metcalfe C, Lees B, Grieve R, Flather M, Normand C, et al. Comparison of hypertonic saline and alternate‐day or daily recombinant human deoxyribonuclease in children with cystic fibrosis: a randomised trial. Lancet 2001;358(9290):1316‐21.

Suri R, Metcalfe C, Wallis C, Bush A. Predicting response to rhDNase and hypertonic saline in children with cystic fibrosis. Pediatric Pulmonology 2004;37(4):305‐10.

Suri R, Wallis C, Bush A. In vivo use of hypertonic saline in CF [abstract]. Pediatric Pulmonology 2000;Suppl 20:125‐6.

Google Scholar

Suri R, Wallis C, Bush A, Thompson S, Normand C, Flather M, et al. A comparative study of hypertonic saline, daily and alternate‐day rhDNase in children with cystic fibrosis. Health Technology Assessment2002; Vol. 34, issue iii:1‐60.

Google Scholar

Suri R, Wallis C, Metcalfe C, Thompson S, Bush A, Shute J. Effects of rhDNase and hypertonic saline on airway inflammation in children with cystic fibrosis [abstract]. Pediatric Pulmonology 2001;Suppl 22:281.

Google Scholar

Suri R, Metcalfe C, Wallis C, Bush A. Assessing the usefulness of outcomes measured in a cystic fibrosis treatment trial. Respiratory Medicine 2007;101(2):254‐60.

Balinotti JE, Rodriguez V, Zaragoza S, Lubovich S, Celiz M, Kofman C, et al. Inhaled 7% hypertonic saline in infants with cystic fibrosis: Is it safe and tolerable?. American Journal of Respiratory and Critical Care Medicine. American Thoracic Society, 2012; Vol. 185. [CENTRAL: 1107400; CRG ID: BD174b; CRS: 5500050000000400; EMBASE: 71989992]

Google Scholar

Teper A, Balinotti J, Rodriguez V, Zaragoza S Lubovich S, Kofman C, Garcia Bournissen F. Effect of early intervention with inhaled hypertonic saline on lung function in infants and toddlers with cystic fibrosis (CF) diagnosed by neonatal screening [abstract]. Journal of Cystic Fibrosis : Official Journal of the European Cystic Fibrosis Society 2015;14 Suppl 1:S49, Abstract no: ePS04.8. [CRS: 5500135000001305]

Teper A, Balinotti VA, Rodriguez VA, Zaragoza SM, Lubovich SL, Kofman C. Inhaled 7% hypertonic saline in infants with cystic fibrosis: is it safe and tolerable? [abstract]. Journal of Cystic Fibrosis 2012;11 Suppl 1:S68, Abstract no: 48. [CRG ID: BD174a; ]

Vanlaethem S, Van Ginderdeuren F, Eyns H, Malfroot A. Influence of inhaled hypertonic saline combined with airway clearance on SpO2, heart rate, dyspnoea and wet sputum weight in hospitalised CF patients [abstract]. Journal of Cystic Fibrosis 2008;7(Suppl 2):S71.

Referencias de los estudios en espera de evaluación

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estudios incluidos
estudios excluidos
otras referencias
otras versiones publicadas

O'Neil K, Moran F, Bradbury I, Downey DG, Rendall J, Tunney MM, et al. Exploring the timing of hypertonic saline (HTS) and airways clearance techniques (ACT) in cystic fibrosis (CF): a crossover study. Thorax 2016;71 Suppl 3:A134, Abstract no: P95. [CENTRAL: 1253123; CRS: 5500135000001677]

Referencias adicionales

Ir a:

estudios incluidos
estudios excluidos
estudios a la espera de valoración
otras versiones publicadas

Abbott J, Dodd ME, Webb AK. Adherence with the use of clearance techniques. In: Rubin BK, Schans CP editor(s). Therapy for Mucus‐Clearance Disorders. New York: Marcel Dekker, 2004:105‐128.

Armijo‐Olivo S, Stiles CR, Hagen NA, Biondo PD, Cummings GG. Asssessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. J Eval Clin Pract 2012;18:12‐18.

Bateman JR, Pavia D, Clark SW. The retention of lung secretions during the night in normal subjects. Clinical Science and Molecular Medicine. Supplement 1978;55(6):523‐7.

Button BM, Wilson C, Dentice R, Cox NS, Middleton A, Tannenbaum E, et al. Physiotherapy for cystic fibrosis in Australia and New Zealand: A clinical practice guideline. Respirology 2016;21:656‐67.

Buzzetti R, Salvatore D, Baldo E, Forneris MP, Lucidi V, Manunza D, et al. An overview of international literature from cystic fibrosis registries: 1. Mortality and survival studies in cystic fibrosis. Journal of Cystic Fibrosis 2009;8(4):229‐37.

Bye PTP, Elkins MR. Other mucoactive agents for cystic fibrosis. Paediatric Respiratory Reviews 2007;8:30‐9.

Cutting GR. Cystic fibrosis. In: Rimon DL, Connor JM, Pyeritz RE, Korf BR editor(s). Principles and Practice of Medical Genetics. 4th Edition. London: Harcourt, 2002:1561‐606.

Google Scholar

de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Australian Journal of Physiotherapy 2009;55(2):129‐33.

Elbourne DR, Altman DG, Higgins JPT, Curtin F, Worthington HV, Vail A. Meta‐analyses involving cross‐over trials: methodological issues. International Journal of Epidemiology 2002;31(1):140‐9.

Elkins M, Jones A, van der Schans CP. Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis. Cochrane Database of Systematic Reviews 2006, Issue 2. [DOI: 10.1002/14651858.CD003147.pub3]

Elkins MR, Bye PT. Inhaled hypertonic saline as a therapy for cystic fibrosis. Current Opinion in Pulmonary Medicine 2006;12(6):445‐52.

Elkins MR, Moseley AM, Sherrington C, Herbert RD, Maher CG. Growth in the Physiotherapy EvidenceDatabase (PEDro) and use of the PEDroscale. British Journal of Sports Medicine 2013;47(4):188‐189.

Hartling L, Ospina M, Liang Y, Dryden DNM, Hooton N, Krebs Seida J, et al. Risk of bias versus quality assessment of randomised controlled trials: cross sectional study. BMJ 2009;339:b4012.

Hartling L, Hamm MP, Milne A, Vandermeer B, Santaguida PL, Ansari M, et al. Testing the Risk of Bias tool showed low reliability between individual reviewers and across consensus assessments of reviewer pairs. Journal of Clinical Epidemiology 2013;66:973‐981.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60.

Higgins JPT, Altman DG (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

King M, Dasgupta B, Tomkiewicz RP, Brown NE. Rheology of cystic fibrosis sputum after in vitro treatment with hypertonic saline alone and in combination with recombinant human deoxyribonuclease. American Journal of Respiratory and Critical Care Medicine 1997;156(1):173‐7.

Laube BL, Geller DE, Lin TC, Dalby RN, Diener‐West M, Zeitlin PL. Positive expiratory pressure changes aerosol distribution in patients with cystic fibrosis. Respiratory Care 2005;50:1438‐1444.

Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro Scale for Rating Quality of Randomized Controlled Trials. Physical Therapy 2003;83(8):713‐21.

Main E, Prasad A, van der Schans CP. Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD002011.pub2]

Google Scholar

Morrison L, Agnew J. Oscillating devices for airway clearance in people with cystic fibrosis. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD006842.pub2]

Robinson KA, Mckoy N, Saldanha I, Odelola OA. Active cycle of breathing technique for cystic fibrosis. Cochrane Database of Systematic Reviews 2010, Issue 11. [DOI: 10.1002/14651858.CD007862.pub2]

Shiwa SR, Costa LCM, Moseley AM, Lopes AD, Reggero CR, Sato TO, et al. Reproducibility of the Portuguese version of the PEDro scale. Cad Saúde Pública 2011;27:2063‐2068.

van der Schans CP, Prasad A, Main E. Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD001401]

Google Scholar

Wark PAB, McDonald VM. Nebulised hypertonic saline for cystic fibrosis. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD001506.pub3]

Wills PJ, Hall RL, Chan W, Cole PJ. Sodium chloride increases the ciliary transportability of cystic fibrosis and bronchiectasis sputum on the mucus‐depleted bovine trachea. Journal of Clinical Investigation 1997;99(1):9‐13.

Wolff RK, Dolovich MB, Obminski G, Newhouse MT. Effects of exercise and eucapnic hyperventilation on bronchial clearance in man. Journal of Applied Physiology: Respiratory, Environmental and Exercise Physiology 1977;43(1):46‐50.

Referencias de otras versiones publicadas de esta revisión

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estudios incluidos
estudios excluidos
estudios a la espera de valoración
otras referencias

Elkins M, Dentice R. Timing of hypertonic saline inhalation for cystic fibrosis. Cochrane Database of Systematic Reviews 2012, Issue 2. [DOI: 10.1002/14651858.CD008816.pub2]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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Dentice 2012

Methods	Randomised, cross‐over trial with concealed allocation, intention‐to‐treat analysis and blinded assessors; investigating the impact of timing of hypertonic saline inhalation in relation to airway clearance techniques. The inhalation blocks were for one day. The three treatments of the allocated timing regimen were performed on each of the three trial days, with no washout day.
Participants	50 adults (mean age 31 years, SD 10, range 18 ‐ 64 years) with a confirmed diagnosis of cystic fibrosis who were clinically stable with an FEV₁ within 10% of the best recorded value in the last 6 months. This trial excluded people who were hypertonic saline naïve or previously intolerant, a lung transplant recipient, colonised with Burkholderia cepacia complex, not clinically stable, haemoptysis greater than 60 mL within the last month, thrombocytopenia or pregnancy.
Interventions	4 mL of 6% hypertonic saline was nebulised via an LC Star nebuliser 3 times per day with the allocated timing regimen for that day. Hypertonic saline was nebulised immediately before or after airway clearance or during (with blocks of inhalation and pauses for airway clearance). The airway clearance technique was optimised for each participant on recruitment to the trial and was standardised for all 3 trial days.
Outcomes	The primary outcome was the change in FEV₁ and FVC (in litres and percentage of the predicted value) recorded prior to and two hours following the middle treatment session of each trial day. Symptom scores at the end of each intervention arm were also recorded: perceived effectiveness, tolerability and satisfaction rated on a 100 mm visual analogue scale. Adverse events and adherence were also recorded.
Notes	PEDro Score: 8/10 [Eligibility criteria: yes; random allocation: yes; concealed allocation: yes; baseline comparability: yes; blind participants: no; blind therapists: no; blind assessors: yes; adequate follow up: yes; intention‐to‐treat analysis: yes; Between‐group comparisons: yes; point estimates and variability: yes. Note: eligibility criteria item does not contribute to total score].
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated random allocation list.
Allocation concealment (selection bias)	Low risk	Sealed opaque envelopes.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Stated "no withdrawals" and intention‐to‐treat analysis used.
Selective reporting (reporting bias)	Low risk	Consistent with the prospectively registered trial protocol.
Other bias	Low risk
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants were unblinded to the timing regimen.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Outcome assessors were blinded.

Van Ginderdeuren 2011

Methods	Randomised, cross‐over trial with concealed allocation, intention to treat analysis and blinded assessors; investigating the impact of timing of hypertonic saline inhalation in relation to airway clearance techniques. The inhalation blocks were for one day. The two treatment days that contributed data to this review involved single treatment of 30 minutes with differing timing of hypertonic saline in relation to physiotherapy airway clearance techniques (i.e. hypertonic saline before or during autogenic drainage). The other day was solely autogenic drainage and did not include hypertonic saline inhalation, so it is not discussed further in this review.
Participants	13 hospitalised participants who were over 14 years (mean age 27 years, range 18 ‐ 37 years). All were productive daily and performed autogenic drainage for their airway clearance. The lung function of participants was not stated but some were noted to be on oxygen therapy. One participant withdrew and outcome data was not included in analysis.
Interventions	4 mL of 6% hypertonic saline before or during 30 minutes of autogenic drainage. The type of nebuliser and use of co‐interventions were not reported.
Outcomes	Outcomes included change in dyspnoea scores at the conclusion of each intervention arm, wet weight of sputum in grams produced during the treatment session, and adverse events and adherence.
Notes	PEDro Score: 8/10 [Eligibility criteria: yes; random allocation: yes; concealed allocation: yes; baseline comparability: yes; blind participants: no; blind therapists: no; blind assessors: yes; adequate follow up: yes; intention‐to‐treat analysis: yes; between‐group comparisons: yes; point estimates and variability: yes. Note: eligibility criteria item does not contribute to total score].
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Allocations were drawn from a box after the box had been shaken.
Allocation concealment (selection bias)	Low risk	Allocations were sealed in opaque envelopes.
Incomplete outcome data (attrition bias) All outcomes	Low risk	One participant was lost to follow up but intention to treat analysis was conducted.
Selective reporting (reporting bias)	Unclear risk	No registered protocol. No protocol available from the author.
Other bias	Low risk
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants were unblinded to the timing regimen.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Outcome assessors were blinded.

FEV₁: forced expiratory volume at one second
FVC: forced vital capacity
SD: standard deviation

Characteristics of excluded studies [ordered by study ID]

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Study	Reason for exclusion
Adde 2004	Intervention not related to the timing of hypertonic saline inhalation.
Amin 2010	Intervention not related to the timing of hypertonic saline inhalation.
Amin 2016	Intervention not related to the timing of hypertonic saline inhalation.
Aquino 2012	Intervention not related to the timing of hypertonic saline inhalation.
Balinotti 2015	Intervention not related to the timing of hypertonic saline inhalation.
Ballmann 2002	Intervention not related to the timing of hypertonic saline inhalation.
Brivio 2013	Intervention not related to the timing of hypertonic saline inhalation.
Brown 2010	Intervention not related to the timing of hypertonic saline inhalation.
Buonpensiero 2010	Intervention not related to the timing of hypertonic saline inhalation.
Cardinale 2003	Intervention not related to the timing of hypertonic saline inhalation.
Chadwick 1997	Intervention not related to the timing of hypertonic saline inhalation.
De Cono 2008	Intervention not related to the timing of hypertonic saline inhalation.
Dentice 2013	Intervention not related to the timing of hypertonic saline inhalation.
Donaldson 2003	Intervention not related to the timing of hypertonic saline inhalation.
Donaldson 2006	Intervention not related to the timing of hypertonic saline inhalation.
Donaldson 2013	Intervention not related to the timing of hypertonic saline inhalation.
Dwyer 2013	Intervention not related to the timing of hypertonic saline inhalation.
Elkins 2006c	Intervention not related to the timing of hypertonic saline inhalation.
Elkins 2006d	Intervention not related to the timing of hypertonic saline inhalation.
Eng 1996	Intervention not related to the timing of hypertonic saline inhalation.
Furnari 2012	Intervention not related to the timing of hypertonic saline inhalation.
Grasemann 2005	Did not involve administration of hypertonic saline.
Grasemann 2013	Did not involve administration of hypertonic saline.
Grieve 2003	Intervention not related to the timing of hypertonic saline inhalation.
Gupta 2012	Intervention not related to the timing of hypertonic saline inhalation.
Herrero 2016	Intervention not related to the timing of hypertonic saline inhalation.
Hofmann 1997	Intervention not related to the timing of hypertonic saline inhalation.
Homola 2013	Intervention not related to the timing of hypertonic saline inhalation.
Kobylyansky 2000	Intervention not related to the timing of hypertonic saline inhalation.
Laube 2009	Intervention not related to the timing of hypertonic saline inhalation.
Mainz 2015	Intervention not related to the timing of hypertonic saline inhalation.
Palacio 2014	Intervention not related to the timing of hypertonic saline inhalation.
Riedler 1996	Intervention not related to the timing of hypertonic saline inhalation.
Robinson 1996	Intervention not related to the timing of hypertonic saline inhalation.
Robinson 1997	Intervention not related to the timing of hypertonic saline inhalation.
Robinson 1999	Intervention not related to the timing of hypertonic saline inhalation.
Ros 2012	Intervention not related to the timing of hypertonic saline inhalation.
Rosenfeld 2012	Intervention not related to the timing of hypertonic saline inhalation.
Ruiz 2012	Intervention not related to the timing of hypertonic saline inhalation.
Suri 2002	Intervention not related to the timing of hypertonic saline inhalation.
Suri 2007	Intervention not related to the timing of hypertonic saline inhalation.
Teper 2012	Intervention not related to the timing of hypertonic saline inhalation.
Vanlaethem 2008	Intervention not related to the timing of hypertonic saline inhalation.

Characteristics of studies awaiting assessment [ordered by study ID]

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O'Neil 2016

Methods	Randomised cross‐over trial. The physiotherapist collecting the outcome measures was blinded.
Participants	14 adults with CF recruited, 13 completed the trial (mean (SD) age 33 years (12), FEV₁% predicted 51 (22), LCI (no. turnovers) 14 (4)).
Interventions	ACTs after HTS inhalation or ACTs during HTS inhalation on alternate days. Between days 10 – 14 of intravenous antibiotic course during a pulmonary exacerbation. ACT treatment consisted of 10 cycles of active cycle of breathing technique using an Acapella^®.
Outcomes	Participants completed a multiple breath washout (MBW) test to obtain LCI and spirometry (FEV₁) at baseline and 90 min post treatment. Sputum collection during 90 min, ease of clearance and satisfaction with treatment was also recorded. Wilcoxon test was used and P < 0.05 was considered significant.
Notes	Abstract only.

ACTs: airways clearance techniques
CF: cystic fibrosis
FEV₁: forced expiratory volume in one second
HTS: hypertonic saline
LCI: lung clearance index
SD: standard deviation

Data and analyses

Open in table viewer

Comparison 1. Inhalation before versus during airway clearance techniques

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 FEV₁ (L) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.1 Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 1 FEV₁ (L).
2 FEV₁ (% pred) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.2 Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 2 FEV₁ (% pred).
3 FVC (L) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.3 Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 3 FVC (L).
4 FVC (% pred) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.4 Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 4 FVC (% pred).
5 Perceived efficacy (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.5 Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 5 Perceived efficacy (mm).
6 Tolerability (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.6 Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 6 Tolerability (mm).
7 Satisfaction (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.7 Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 7 Satisfaction (mm).
8 Dyspnoea Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.8 Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 8 Dyspnoea.
9 Sputum wet weight Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.9 Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 9 Sputum wet weight.

Open in table viewer

Comparison 2. Inhalation before versus after airway clearance techniques

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 FEV₁ (L) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.1 Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 1 FEV₁ (L).
2 FEV₁ (% pred) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.2 Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 2 FEV₁ (% pred).
3 FVC (L) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.3 Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 3 FVC (L).
4 FVC (% pred) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.4 Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 4 FVC (% pred).
5 Perceived efficacy (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.5 Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 5 Perceived efficacy (mm).
6 Tolerability (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.6 Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 6 Tolerability (mm).
7 Satisfaction (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.7 Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 7 Satisfaction (mm).

Open in table viewer

Comparison 3. Inhalation during versus after airway clearance techniques

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 FEV₁ (L) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.1 Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 1 FEV₁ (L).
2 FEV₁ (% pred) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.2 Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 2 FEV₁ (% pred).
3 FVC (L) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.3 Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 3 FVC (L).
4 FVC (% pred) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.4 Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 4 FVC (% pred).
5 Perceived efficacy (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.5 Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 5 Perceived efficacy (mm).
6 Tolerability (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.6 Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 6 Tolerability (mm).
7 Satisfaction (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 3.7 Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 7 Satisfaction (mm).

Figure 1

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 1 FEV1 (L).

Analysis 1.1

Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 1 FEV₁ (L).

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Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 2 FEV1 (% pred).

Analysis 1.2

Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 2 FEV₁ (% pred).

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Analysis 1.3

Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 3 FVC (L).

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Analysis 1.4

Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 4 FVC (% pred).

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Analysis 1.5

Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 5 Perceived efficacy (mm).

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Analysis 1.6

Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 6 Tolerability (mm).

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Analysis 1.7

Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 7 Satisfaction (mm).

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Analysis 1.8

Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 8 Dyspnoea.

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Analysis 1.9

Comparison 1 Inhalation before versus during airway clearance techniques, Outcome 9 Sputum wet weight.

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Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 1 FEV1 (L).

Analysis 2.1

Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 1 FEV₁ (L).

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Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 2 FEV1 (% pred).

Analysis 2.2

Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 2 FEV₁ (% pred).

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Analysis 2.3

Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 3 FVC (L).

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Analysis 2.4

Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 4 FVC (% pred).

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Analysis 2.5

Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 5 Perceived efficacy (mm).

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Analysis 2.6

Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 6 Tolerability (mm).

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Analysis 2.7

Comparison 2 Inhalation before versus after airway clearance techniques, Outcome 7 Satisfaction (mm).

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Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 1 FEV1 (L).

Analysis 3.1

Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 1 FEV₁ (L).

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Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 2 FEV1 (% pred).

Analysis 3.2

Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 2 FEV₁ (% pred).

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Analysis 3.3

Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 3 FVC (L).

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Analysis 3.4

Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 4 FVC (% pred).

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Analysis 3.5

Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 5 Perceived efficacy (mm).

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Analysis 3.6

Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 6 Tolerability (mm).

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Analysis 3.7

Comparison 3 Inhalation during versus after airway clearance techniques, Outcome 7 Satisfaction (mm).

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Comparison 1. Inhalation before versus during airway clearance techniques

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 FEV₁ (L) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

2 FEV₁ (% pred) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

3 FVC (L) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

4 FVC (% pred) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

5 Perceived efficacy (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

6 Tolerability (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

7 Satisfaction (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

8 Dyspnoea Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

9 Sputum wet weight Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

Comparison 1. Inhalation before versus during airway clearance techniques

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Comparison 2. Inhalation before versus after airway clearance techniques

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 FEV₁ (L) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

2 FEV₁ (% pred) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

3 FVC (L) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

4 FVC (% pred) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

5 Perceived efficacy (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

6 Tolerability (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

7 Satisfaction (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

Comparison 2. Inhalation before versus after airway clearance techniques

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Comparison 3. Inhalation during versus after airway clearance techniques

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 FEV₁ (L) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

2 FEV₁ (% pred) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

3 FVC (L) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

4 FVC (% pred) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

5 Perceived efficacy (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

6 Tolerability (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

7 Satisfaction (mm) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Totals not selected

Comparison 3. Inhalation during versus after airway clearance techniques

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Referencias

Referencias de los estudios incluidos en esta revisión

Dentice 2012 {published data only}

Van Ginderdeuren 2011 {published and unpublished data}

Referencias de los estudios excluidos de esta revisión

Adde 2004 {published data only}

Amin 2010 {published data only}

Amin 2016 {published data only}

Aquino 2012 {published data only}

Balinotti 2015 {published data only}

Ballmann 2002 {published data only}

Brivio 2013 {published data only}

Brown 2010 {published data only}

Buonpensiero 2010 {published data only}

Cardinale 2003 {published data only}

Chadwick 1997 {published data only}

De Cono 2008 {published data only}

Dentice 2013 {published data only}

Donaldson 2003 {published data only}

Donaldson 2006 {published data only}

Donaldson 2013 {published data only}

Dwyer 2013 {published data only}

Elkins 2006c {published data only}

Elkins 2006d {published data only}

Eng 1996 {published data only}

Furnari 2012 {published data only}

Grasemann 2005 {published data only}

Grasemann 2013 {published data only}

Grieve 2003 {published data only}

Gupta 2012 {published data only}

Herrero 2016 {published data only}

Hofmann 1997 {published data only}

Homola 2013 {published data only}

Kobylyansky 2000 {published data only}

Laube 2009 {published data only}

Mainz 2015 {published data only}

Palacio 2014 {published data only}

Riedler 1996 {published data only}

Robinson 1996 {published data only}

Robinson 1997 {published data only}

Robinson 1999 {published data only}

Ros 2012 {published data only}

Rosenfeld 2012 {published data only}

Ruiz 2012 {published data only}

Suri 2002 {published data only}

Suri 2007 {published data only}

Teper 2012 {published data only}

Vanlaethem 2008 {published data only}

Referencias de los estudios en espera de evaluación

O'Neil 2016 {published data only}

Referencias adicionales

Abbott 2004

Armijo‐Olivo 2012

Bateman 1978

Button 2016

Buzzetti 2009

Bye 2007

Cutting 2002

de Morton 2009

Elbourne 2002

Elkins 2006a

Elkins 2006b

Elkins 2013

Hartling 2009

Hartling 2013

Higgins 2003

Higgins 2011

King 1997

Laube 2005

Maher 2003

Main 2009

Morrison 2009

Robinson 2010

Shiwa 2011

van der Schans 2009

Wark 2009

Wills 1997

Wolff 1977