Ullah Saad Ehsan, Zahoor Mohammad Munim, Gupta Swatika, Boparai Sukhman, Muneeb Muhammad, Eltieb Shahda A H, Shankar Abhirami, Kidiavai Harriet Mmaitsi, Vohra Rimsha Rahim, Devi Anjuli, Bhura Zainab Asif, Aslam Zaid Muhammad, Shoaib Mudassir
Department of Medicine, Shaikh Zayed Hospital, Lahore, Pakistan.
Department of Medicine, Lahore Medical and Dental College, Lahore, Pakistan.
Can J Respir Ther. 2023 Jan 20;59:1-7. doi: 10.29390/cjrt-2022-046. eCollection 2023.
Inhaled hypertonic saline (HS) reduces pulmonary exacerbations in patients with cystic fibrosis (CF) aged 6 or more years. However, the effectiveness of HS in improving clinical outcomes in younger children aged 6 or less years is not established. This study examines the efficacy of HS in younger CF patients.
Searches were conducted across three databases (Medline, Cochrane Central and EMBASE) from inception through July 2022. Randomized controlled trials assessing the impact of HS in younger CF patients were included. Trials involving only patients greater than 6 years or control group other than isotonic saline (IS) were excluded. Outcomes measured included lung clearance index (LCI), cystic fibrosis questionnaire (CFQ-R) score, spirometry measures, oxygen saturation, respiratory rate, height and weight. Outcomes were reported as mean differences (MDs) with 95% confidence intervals.
Seven studies ( = 390 patients) were included in this review. HS significantly reduced the LCI (MD: -0.67; 95%CI, -1.05 to 0.29, P = 0.0006) compared to IS. In addition, HS was associated with significant improvements in height (MD: 2.23; 95%CI, -0.00 to 4.46, P = 0.05) and CFQ-R (MD: 4.30; 95%CI, 0.65-7.95, P = 0.02), but not in oxygen saturation (MD: -0.15; 95%CI, -0.54 to 0.25, P = 0.47), respiratory rate (MD: -0.21; 95%CI, -2.19 to 1.77, P = 0.83) or weight (MD: 0.70; 95%CI, -0.47 to 1.87, P = 0.24). Furthermore, HS did not significantly improve spirometry measures, including FEV (MD: -0.11; 95%CI, -0.21 to 0.43, P = 0.51) and forced vital capacity (MD: 0.27; 95%CI, -0.49 to 1.04, P = 0.48), but significantly improved FEF (MD: 0.12; 95% CI, 0.05-0.20; P = 0.002).
Treatment with HS in younger children with CF improves lung clearance, symptoms and quality of life. FEF may prove a more sensitive measure for assessing intervention related improvements in pediatric CF trials.
The findings support HS as a therapeutic method in CF-affected children.
吸入高渗盐水（HS）可减少6岁及以上囊性纤维化（CF）患者的肺部加重发作。然而，HS对6岁及以下年幼儿童临床结局改善的有效性尚未确定。本研究探讨HS在年幼CF患者中的疗效。
检索了从建库至2022年7月的三个数据库（Medline、Cochrane Central和EMBASE）。纳入评估HS对年幼CF患者影响的随机对照试验。排除仅涉及6岁以上患者或使用等渗盐水（IS）以外的对照组的试验。测量的结局包括肺清除指数（LCI）、囊性纤维化问卷（CFQ-R）评分、肺功能测定指标、血氧饱和度、呼吸频率、身高和体重。结局以平均差（MDs）及95%置信区间报告。
本综述纳入了7项研究（n = 390例患者）。与IS相比，HS显著降低了LCI（MD：-0.67；95%CI，-1.05至-0.29，P = 0.0006）。此外，HS与身高（MD：2.23；95%CI，-0.00至4.46，P = 0.05）和CFQ-R（MD：4.30；95%CI，0.65 - 7.95，P = 0.02）的显著改善相关，但与血氧饱和度（MD：-0.15；95%CI，-0.54至0.25，P = 0.47）、呼吸频率（MD：-0.21；95%CI，-2.19至1.77，P = 0.83）或体重（MD：0.70；95%CI，-0.47至1.87，P = 0.24）无关。此外，HS未显著改善肺功能测定指标，包括第一秒用力呼气容积（FEV，MD：-0.11；95%CI，-0.21至0.43，P = 0.51）和用力肺活量（MD：0.27；95%CI，-0.49至1.04，P = 0.48），但显著改善了用力呼气流量（FEF，MD：0.12；95%CI，0.05 - 0.20；P = 0.002）。
年幼CF患儿使用HS治疗可改善肺清除、症状和生活质量。在儿科CF试验中，FEF可能是评估干预相关改善的更敏感指标。
这些发现支持HS作为CF患儿的一种治疗方法。
