Hypertonic Saline Treatment No More Efficient Before than During Airway Clearance in CF

Hypertonic Saline Treatment No More Efficient Before than During Airway Clearance in CF

Treatment with hypertonic saline administered before airway clearance is no more effective than when administered during airway clearance in cystic fibrosis (CF) patients, according to a recent study.

Current guidelines call for the procedure to be done before, rather than during, airway clearance, though some experts disagree.

A team of researchers led by Judy Bradley, director of the Clinical Research Facility at Queen’s University in Belfast, Northern Ireland, decided to assess which timing was more effective. Their report,Timing of hypertonic saline and airway clearance techniques in adults with cystic fibrosis during pulmonary exacerbation: pilot data from a randomized crossover study,” appears in the journal BMJ Open Respiratory Research.

In the study, 13 adult patients with CF were randomly divided into two groups to either receive hypertonic saline treatment before or during airway clearance, on consecutive days. Researchers assessed patients’ lung clearance index and spirometry at the start of the experiment and 90 minutes following treatment.

Results showed no significant difference in either the lung clearance index or spirometry readings before and after treatment between the two groups. Nor were their differences in the weight of the patients’ sputum, perceived ease of clearance, or satisfaction.

However, treating with hypertonic saline during airway clearance took significantly less time than treating before airway clearance.

Authors concluded that administering hypertonic saline before or during airway clearance is equally effective. They also suggested that the lung clearance index “may not be a suitable short-term end point for airways clearance trials, as response is unpredictable.”

Airway clearance techniques, which involve coughing and huffing, can help people with CF clear mucus from their lungs and should be part of routine treatment in CF patients, they said. Hypertonic saline stimulates the movement of the tiny hair-like structures lining the inside of the airways, helping patients clear mucus.


  1. Ryan says:

    I’m not sure what “guidelines” we’re speaking of, but it’s pretty much accepted throughout the CF medical community that both Hypertonic Saline and Pulmozyme can be done DURING airway clearance and the antibiotic must be done after. I don’t know what authority says it has to be done before because I haven’t heard that anytime recently.


      I have never heard of meds being administered prior to airway clearence. This seems absurd. I have an 8 y.o. with CF amd amazing pfts. We have always began with airway clearence, albuterol and then hypertonic saline, at least twice a day, of coarse and pulmozyme 1x. This works very well. This was the recommendation of Dr.Mark Pian of Rady Children’s Hospital San Diego

  2. Scott says:

    Hi. Can someone please tell me how it’s possible to do hypertonic saline “during” airway clearance? I nebulize hypertonic saline for 20 minutes prior to using the flutter for airway clearance. What device do you use to do both at the same time?
    Thanks in advance.

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