The Efficacy and Tolerability of the Combination of Inhaled Hypertonic Saline and Hyaluronic Acid versus Inhaled Hypertonic Saline in Patients with Cystic Fibrosis

Background: Cystic fibrosis (CF) is the most common life-shortening autosomal recessive disease found among Caucasians. It is known to target many organs systems such as the lungs, liver, and intestines but the most affected organ is the respiratory tract. Patients with CF usually develop some type of pulmonary dysfunction resulting in frequent asthma-type exacerbations and chronic bacterial infections due to excessive mucus adhesion. Maintenance therapy with hypertonic saline (HS) has shown to be beneficial in helping with mucociliary clearance but compliance is low due to a high profile of side effects. Recent studies have shown that hyaluronic acid (HA) in addition to HS helps improve the tolerability of HS. The purpose of this review is to further evaluate the benefits of combination therapy on tolerability and efficacy in patients with CF. Methods: A comprehensive search of the medical literature was conducted using various search modalities including Medline/OVID, EBSCOhost/CINAHL, Web of Science, and Google scholar. Keywords used included: cystic fibrosis, hypertonic saline, and hyaluronic acid. Results: Three articles met the inclusion and exclusion criteria for this systematic review. All three articles were randomized control trials which showed a statistically significant improvement regarding tolerability with the addition of HA to HS. Conclusion: This systematic review provides evidence that supports the indication for combination therapy with HA to improve tolerability and efficacy of HS therapy alone in patients with CF. However, these results would be strengthened with larger and longer randomized controlled studies. Keywords: cystic fibrosis, hypertonic saline, hyaluronic aci