Elkins Mark, Dentice Ruth
Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia.
Cochrane Database Syst Rev. 2012 Feb 15(2):CD008816. doi: 10.1002/14651858.CD008816.pub2.
Inhalation of hypertonic saline improves sputum rheology, accelerates mucociliary clearance and improves clinical outcomes of people with cystic fibrosis.
To determine whether the timing of hypertonic saline inhalation (in relation to airway clearance techniques or in relation to time of day) has an impact on its clinical efficacy in people with cystic fibrosis.
We identified relevant randomised and quasi-randomised controlled trials from the Cochrane Cystic Fibrosis Trials Register, the Physiotherapy Evidence Database (PEDro), and international cystic fibrosis conference proceedings.Date of the last search of the Group's Cystic Fibrosis Trials Register: 6 December 2011.
Any trial of hypertonic saline in people with cystic fibrosis where timing of inhalation was the randomised element in the study protocol with either: inhalation up to six hours before airway clearance techniques compared to inhalation during airway clearance techniques compared to inhalation up to six hours after airway clearance techniques; or morning compared to evening inhalation with any definition provided by the author.
Both authors independently assessed the trials identified by the search for potential inclusion in the review.
The search strategy identified 50 trial reports which represented 24 unique studies. One study, published only as an abstract, is awaiting further assessment. None of the other studies compared timing regimens for the inhalation of hypertonic saline and we excluded these from the review.
AUTHORS' CONCLUSIONS: This review did not identify any evidence comparing the timing of hypertonic saline inhalation in relation to airway clearance physiotherapy. Until such evidence becomes available, clinicians could advise patients to inhale hypertonic saline before airway clearance, because this is the only regimen evaluated in the studies that established the efficacy of the use of hypertonic saline. This review also did not identify any evidence comparing the timing of hypertonic saline inhalation in relation to time of day. Until such evidence becomes available, clinicians could advise patients to inhale hypertonic saline morning and evening; but if only one dose per day is tolerated, the time of day at which it is inhaled could be based on convenience or tolerability.Given the competing theoretical rationales about why hypertonic saline could be more effective if inhaled at certain times, a trial comparing these various timing regimens should be conducted.
吸入高渗盐水可改善痰液流变学，加速黏液纤毛清除，并改善囊性纤维化患者的临床结局。
确定吸入高渗盐水的时间（与气道清除技术相关或与一天中的时间相关）是否会影响其对囊性纤维化患者的临床疗效。
我们从Cochrane囊性纤维化试验注册库、物理治疗证据数据库（PEDro）以及国际囊性纤维化会议论文集中识别出相关的随机和半随机对照试验。该研究组囊性纤维化试验注册库的最后检索日期为2011年12月6日。
任何针对囊性纤维化患者的高渗盐水试验，其中吸入时间是研究方案中的随机因素，具体如下：与在气道清除技术期间吸入相比，在气道清除技术前长达6小时吸入；与在气道清除技术后长达6小时吸入相比，在气道清除技术期间吸入；或者作者提供的任何定义下，早晨吸入与晚上吸入相比。
两位作者独立评估检索到的试验，以确定其是否可能纳入本综述。
检索策略识别出50份试验报告，代表24项独特的研究。一项仅以摘要形式发表的研究正在等待进一步评估。其他研究均未比较高渗盐水吸入的时间方案，我们将这些研究排除在本综述之外。
本综述未发现任何比较高渗盐水吸入时间与气道清除物理治疗关系的证据。在获得此类证据之前，临床医生可建议患者在气道清除前吸入高渗盐水，因为这是已证实高渗盐水使用疗效的研究中唯一评估的方案。本综述也未发现任何比较高渗盐水吸入时间与一天中时间关系的证据。在获得此类证据之前，临床医生可建议患者早晚吸入高渗盐水；但如果每天只能耐受一剂，则吸入时间可根据便利性或耐受性来确定。鉴于关于为何在某些时间吸入高渗盐水可能更有效的理论依据相互矛盾，应开展一项比较这些不同时间方案的试验。
