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      Effect of hypertonic saline, amiloride, and cough on mucociliary clearance in patients with cystic fibrosis.

      American journal of respiratory and critical care medicine
      Adolescent, Adult, Aerosols, Amiloride, administration & dosage, therapeutic use, Analysis of Variance, Confounding Factors (Epidemiology), Cough, chemically induced, physiopathology, Cystic Fibrosis, therapy, Drug Combinations, Expectorants, Female, Forced Expiratory Volume, drug effects, Humans, Isotonic Solutions, Lung, Male, Mucociliary Clearance, Saline Solution, Hypertonic, Technetium Tc 99m Sulfur Colloid, diagnostic use

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          Abstract

          In patients with cystic fibrosis (CF), dehydration of airway secretions leads to a decrease in mucociliary clearance (MCC). We examined the acute effect of MCC of a single administration by aerosolization of hypertonic saline (7%) (HS), amiloride (0.3% in 0.12% NaCl) (AML) and a combination of AML and HS (AML + HS) in 12 patients with CF using a radioaerosol technique. Isotonic saline [0.9%] (IS) was used as a control solution. As both the AML and HS solutions induced cough in some patients, the last nine patients studied also underwent a cough clearance day. This was to eliminate the possible confounding effect of cough on MCC measurement. Patients ranged from 18 to 28 yr (mean +/- SD, 22 +/- 3) with an FEV1 of 27 to 112% predicted (61 +/- 30%). Following deposition of the radioaerosol, baseline clearance was assessed for 30 min. This was followed by a 30-min intervention period. Assessment of post-intervention clearance for a further 30 min was then performed. Comparison of the amount of radioaerosol cleared from the right lung was made at 60 min (%C60) and 90 min (%C90) using repeated measures ANOVA. The percent cleared at 60 and 90 min was significantly increased with HS (%C60 = 26.5%, %C90 = 29.4%) and the combination of AML + HS (%C60 = 23.1%, %C90 = 27.4%) compared with both IS (%C60 = 14.7%, %C90 = 17.5%) and COUGH (%C60 = 18.0%, %C90 = 19.5%), p < 0.01. Inhalation of hypertonic saline is a potentially useful treatment in patients with cystic fibrosis.

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