The timing of hypertonic saline (HTS) and airway clearance techniques (ACT) in adults with Cystic Fibrosis (CF) during pulmonary exacerbation: Pilot data from a randomised crossover study.

Judy Bradley; Katherine O'Neill; Fidelma Moran; Michael M. Tunney; J Stuart Elborn; Ian Bradbury; Damian G. Downey; Jackie Rendall

doi:10.1136/bmjresp-2016-000168

The timing of hypertonic saline (HTS) and airway clearance techniques (ACT) in adults with Cystic Fibrosis (CF) during pulmonary exacerbation: Pilot data from a randomised crossover study.

Judy Bradley, Katherine O'Neill, Fidelma Moran, Michael M. Tunney, J Stuart Elborn, Ian Bradbury, Damian G. Downey, Jackie Rendall

Research output: Contribution to journal › Article › peer-review

12 Citations (Scopus)

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Abstract

Background: Streamlining the timing of treatments in Cystic Fibrosis (CF) is important to optimise adherence whilst ensuring efficacy. The optimal timing of treatment with hypertonic saline (HTS) and airway clearance techniques (ACT) is unknown.

Objectives: This study hypothesised that HTS before ACT would be more effective than HTS during ACT as measured by lung clearance index (LCI).

Methods: Adults with CF providing written informed consent were randomised to a crossover trial of HTS before ACT or HTS during ACT on consecutive days. ACT treatment consisted of Acapella® Duet. Patients completed LCI and spirometry at baseline and 90 mins post treatment. Mean difference (MD) and 95% confidence intervals (95% CI) were reported.

Results: 13 subjects completed the study (mean [SD] age 33 [12] years, FEV1% predicted 51% [22], LCI (no. turnovers) 14 [4]). Comparing the two treatments (HTS before ACT vs HTS during ACT), the change from baseline to 90 mins post treatment in LCI (MD [95% CI] -0.02 [-0.63 to 0.59]) and FEV1% predicted (MD [95% CI] -0.25 [-2.50 to 1.99]) was not significant. There was no difference in sputum weight (MD [95% CI] -3.0 [-14.9 to 8.9]), patient perceived ease of clearance (MD [95% CI] 0.4 [-0.6 to 1.3) or satisfaction (MD [95% CI] 0.4 [-0.6 to 1.5]). The time taken for HTS during ACT was significantly shorter (MD [95% CI] 14.7 [9.8 to 19.6]).

Conclusions: In this pilot study, HTS before ACT was no more effective than HTS during ACT as measured by lung clearance index (LCI).

Original language	English
Article number	e000168
Journal	BMJ Open Respiratory Research
Volume	4
Issue number	1
DOIs	https://doi.org/10.1136/bmjresp-2016-000168
Publication status	Published - 12 Jan 2017

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Timing of hypertonic saline and airway clearance techniques in adults with cystic fibrosis during pulmonary exacerbation
Copyright 2017 the authors. This is an open access Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction for non-commercial purposes, provided the author and source are cited.
Final published version, 1.17 MBLicence: CC BY-NC

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Bradley, J., O'Neill, K., Moran, F., Tunney, M. M., Elborn, J. S., Bradbury, I., Downey, D. G., & Rendall, J. (2017). The timing of hypertonic saline (HTS) and airway clearance techniques (ACT) in adults with Cystic Fibrosis (CF) during pulmonary exacerbation: Pilot data from a randomised crossover study. BMJ Open Respiratory Research, 4(1), [e000168]. https://doi.org/10.1136/bmjresp-2016-000168

Bradley, Judy ; O'Neill, Katherine ; Moran, Fidelma ; Tunney, Michael M. ; Elborn, J Stuart ; Bradbury, Ian ; Downey, Damian G. ; Rendall, Jackie. / The timing of hypertonic saline (HTS) and airway clearance techniques (ACT) in adults with Cystic Fibrosis (CF) during pulmonary exacerbation: Pilot data from a randomised crossover study. In: BMJ Open Respiratory Research. 2017 ; Vol. 4, No. 1.

@article{76823b0cef024b498383de0ff05aa850,

title = "The timing of hypertonic saline (HTS) and airway clearance techniques (ACT) in adults with Cystic Fibrosis (CF) during pulmonary exacerbation: Pilot data from a randomised crossover study.",

abstract = "Background: Streamlining the timing of treatments in Cystic Fibrosis (CF) is important to optimise adherence whilst ensuring efficacy. The optimal timing of treatment with hypertonic saline (HTS) and airway clearance techniques (ACT) is unknown.Objectives: This study hypothesised that HTS before ACT would be more effective than HTS during ACT as measured by lung clearance index (LCI). Methods: Adults with CF providing written informed consent were randomised to a crossover trial of HTS before ACT or HTS during ACT on consecutive days. ACT treatment consisted of Acapella{\textregistered} Duet. Patients completed LCI and spirometry at baseline and 90 mins post treatment. Mean difference (MD) and 95% confidence intervals (95% CI) were reported.Results: 13 subjects completed the study (mean [SD] age 33 [12] years, FEV1% predicted 51% [22], LCI (no. turnovers) 14 [4]). Comparing the two treatments (HTS before ACT vs HTS during ACT), the change from baseline to 90 mins post treatment in LCI (MD [95% CI] -0.02 [-0.63 to 0.59]) and FEV1% predicted (MD [95% CI] -0.25 [-2.50 to 1.99]) was not significant. There was no difference in sputum weight (MD [95% CI] -3.0 [-14.9 to 8.9]), patient perceived ease of clearance (MD [95% CI] 0.4 [-0.6 to 1.3) or satisfaction (MD [95% CI] 0.4 [-0.6 to 1.5]). The time taken for HTS during ACT was significantly shorter (MD [95% CI] 14.7 [9.8 to 19.6]).Conclusions: In this pilot study, HTS before ACT was no more effective than HTS during ACT as measured by lung clearance index (LCI).",

author = "Judy Bradley and Katherine O'Neill and Fidelma Moran and Tunney, {Michael M.} and Elborn, {J Stuart} and Ian Bradbury and Downey, {Damian G.} and Jackie Rendall",

year = "2017",

month = jan,

day = "12",

doi = "10.1136/bmjresp-2016-000168",

language = "English",

volume = "4",

journal = "BMJ Open Respiratory Research",

issn = "2052-4439",

publisher = "BMJ Publishing Group",

number = "1",

}

Bradley, J , O'Neill, K, Moran, F, Tunney, MM , Elborn, JS, Bradbury, I, Downey, DG & Rendall, J 2017, 'The timing of hypertonic saline (HTS) and airway clearance techniques (ACT) in adults with Cystic Fibrosis (CF) during pulmonary exacerbation: Pilot data from a randomised crossover study.', BMJ Open Respiratory Research, vol. 4, no. 1, e000168. https://doi.org/10.1136/bmjresp-2016-000168

The timing of hypertonic saline (HTS) and airway clearance techniques (ACT) in adults with Cystic Fibrosis (CF) during pulmonary exacerbation: Pilot data from a randomised crossover study. / Bradley, Judy ; O'Neill, Katherine; Moran, Fidelma; Tunney, Michael M.; Elborn, J Stuart; Bradbury, Ian; Downey, Damian G.; Rendall, Jackie.

In: BMJ Open Respiratory Research, Vol. 4, No. 1, e000168, 12.01.2017.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The timing of hypertonic saline (HTS) and airway clearance techniques (ACT) in adults with Cystic Fibrosis (CF) during pulmonary exacerbation: Pilot data from a randomised crossover study.

AU - Bradley, Judy

AU - O'Neill, Katherine

AU - Moran, Fidelma

AU - Tunney, Michael M.

AU - Elborn, J Stuart

AU - Bradbury, Ian

AU - Downey, Damian G.

AU - Rendall, Jackie

PY - 2017/1/12

Y1 - 2017/1/12

N2 - Background: Streamlining the timing of treatments in Cystic Fibrosis (CF) is important to optimise adherence whilst ensuring efficacy. The optimal timing of treatment with hypertonic saline (HTS) and airway clearance techniques (ACT) is unknown.Objectives: This study hypothesised that HTS before ACT would be more effective than HTS during ACT as measured by lung clearance index (LCI). Methods: Adults with CF providing written informed consent were randomised to a crossover trial of HTS before ACT or HTS during ACT on consecutive days. ACT treatment consisted of Acapella® Duet. Patients completed LCI and spirometry at baseline and 90 mins post treatment. Mean difference (MD) and 95% confidence intervals (95% CI) were reported.Results: 13 subjects completed the study (mean [SD] age 33 [12] years, FEV1% predicted 51% [22], LCI (no. turnovers) 14 [4]). Comparing the two treatments (HTS before ACT vs HTS during ACT), the change from baseline to 90 mins post treatment in LCI (MD [95% CI] -0.02 [-0.63 to 0.59]) and FEV1% predicted (MD [95% CI] -0.25 [-2.50 to 1.99]) was not significant. There was no difference in sputum weight (MD [95% CI] -3.0 [-14.9 to 8.9]), patient perceived ease of clearance (MD [95% CI] 0.4 [-0.6 to 1.3) or satisfaction (MD [95% CI] 0.4 [-0.6 to 1.5]). The time taken for HTS during ACT was significantly shorter (MD [95% CI] 14.7 [9.8 to 19.6]).Conclusions: In this pilot study, HTS before ACT was no more effective than HTS during ACT as measured by lung clearance index (LCI).

AB - Background: Streamlining the timing of treatments in Cystic Fibrosis (CF) is important to optimise adherence whilst ensuring efficacy. The optimal timing of treatment with hypertonic saline (HTS) and airway clearance techniques (ACT) is unknown.Objectives: This study hypothesised that HTS before ACT would be more effective than HTS during ACT as measured by lung clearance index (LCI). Methods: Adults with CF providing written informed consent were randomised to a crossover trial of HTS before ACT or HTS during ACT on consecutive days. ACT treatment consisted of Acapella® Duet. Patients completed LCI and spirometry at baseline and 90 mins post treatment. Mean difference (MD) and 95% confidence intervals (95% CI) were reported.Results: 13 subjects completed the study (mean [SD] age 33 [12] years, FEV1% predicted 51% [22], LCI (no. turnovers) 14 [4]). Comparing the two treatments (HTS before ACT vs HTS during ACT), the change from baseline to 90 mins post treatment in LCI (MD [95% CI] -0.02 [-0.63 to 0.59]) and FEV1% predicted (MD [95% CI] -0.25 [-2.50 to 1.99]) was not significant. There was no difference in sputum weight (MD [95% CI] -3.0 [-14.9 to 8.9]), patient perceived ease of clearance (MD [95% CI] 0.4 [-0.6 to 1.3) or satisfaction (MD [95% CI] 0.4 [-0.6 to 1.5]). The time taken for HTS during ACT was significantly shorter (MD [95% CI] 14.7 [9.8 to 19.6]).Conclusions: In this pilot study, HTS before ACT was no more effective than HTS during ACT as measured by lung clearance index (LCI).

U2 - 10.1136/bmjresp-2016-000168

DO - 10.1136/bmjresp-2016-000168

M3 - Article

VL - 4

JO - BMJ Open Respiratory Research

JF - BMJ Open Respiratory Research

SN - 2052-4439

IS - 1

M1 - e000168

ER -