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The effectiveness of hyaluronic acid in reducing adverse effects associated with inhaled hypertonic saline therapy in patients with cystic fibrosis: A systematic review and meta-analysis

BACKGROUND: Inhaled hypertonic saline (HS) is an effective mucolytic agent in patients with cystic fibrosis (CF). However, adverse events can impair the clinical utility of hypertonic saline (HS) in this patient population. In this study, we aimed to investigate the effectiveness of hyaluronic acid...

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Autores principales: Arshid, Sana, Ullah, *Saad Ehsan, Imran, Junaid, Syed, Meeran Asher, Choradia, Aakash, Gousy, Nicole, Boparai, Sukhman, Shoaib, Mudassir, Shah, Bidhan Bikram, Netha, Aadarsh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Canadian Society of Respiratory Therapists 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10621800/
https://www.ncbi.nlm.nih.gov/pubmed/37927455
http://dx.doi.org/10.29390/001c.89093
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author Arshid, Sana
Ullah, *Saad Ehsan
Imran, Junaid
Syed, Meeran Asher
Choradia, Aakash
Gousy, Nicole
Boparai, Sukhman
Shoaib, Mudassir
Shah, Bidhan Bikram
Netha, Aadarsh
author_facet Arshid, Sana
Ullah, *Saad Ehsan
Imran, Junaid
Syed, Meeran Asher
Choradia, Aakash
Gousy, Nicole
Boparai, Sukhman
Shoaib, Mudassir
Shah, Bidhan Bikram
Netha, Aadarsh
author_sort Arshid, Sana
collection PubMed
description BACKGROUND: Inhaled hypertonic saline (HS) is an effective mucolytic agent in patients with cystic fibrosis (CF). However, adverse events can impair the clinical utility of hypertonic saline (HS) in this patient population. In this study, we aimed to investigate the effectiveness of hyaluronic acid (HA) in reducing these adverse events. METHODS: A literature search was conducted across three electronic databases (Medline, Cochrane Central, and EMBASE) from inception through February 2023. Randomized controlled trials (RCTs) assessing the impact of hyaluronic acid (HA) in reducing adverse events in patients taking hypertonic saline (HS) for CF were included in the analysis. Outcomes of interest included cough, throat irritation, unpleasant taste, and FEV1. Evaluations were reported as risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CI). The Cochrane Risk of Bias Tool (CRBT) was employed to assess the quality of RCTs. The New Castle Ottawa Scale was used to assess the quality of observational studies. RESULTS: From the 1960 articles retrieved from the initial search, five relevant studies (n=236 patients) were included in the final analysis. Compared with patients only on HS, patients with HS and HA were significantly less likely to experience cough (RR: 0.45; 95% CI, 0.28–0.72, p=0.001), throat irritation (RR: 0.43; 95% CI, 0.22–0.81, p= 0.009), and unpleasant smell (RR: 0.43; 95% CI, 0.23 – 0.80, p=0.09). In addition, patients with HS with HA had significantly less forced expiratory volume (FEV1) (MD: -2.97; 95% CI, -3.79—2.15, p=0.52) compared to patients only on HS. DISCUSSION: The addition of HA to HS was linked to a better tolerability profile. When HS was coupled with HA, there was a reduction in all side effects. This may permit tolerance of the medication in otherwise difficult patients, improve adherence to patients receiving frequent inhalations, and improve therapeutic outcomes. CONCLUSION: The addition of HA is advantageous in CF patients who require continuous HS therapy and have previously shown poor tolerance to therapy.
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spelling pubmed-106218002023-11-03 The effectiveness of hyaluronic acid in reducing adverse effects associated with inhaled hypertonic saline therapy in patients with cystic fibrosis: A systematic review and meta-analysis Arshid, Sana Ullah, *Saad Ehsan Imran, Junaid Syed, Meeran Asher Choradia, Aakash Gousy, Nicole Boparai, Sukhman Shoaib, Mudassir Shah, Bidhan Bikram Netha, Aadarsh Can J Respir Ther Review Article BACKGROUND: Inhaled hypertonic saline (HS) is an effective mucolytic agent in patients with cystic fibrosis (CF). However, adverse events can impair the clinical utility of hypertonic saline (HS) in this patient population. In this study, we aimed to investigate the effectiveness of hyaluronic acid (HA) in reducing these adverse events. METHODS: A literature search was conducted across three electronic databases (Medline, Cochrane Central, and EMBASE) from inception through February 2023. Randomized controlled trials (RCTs) assessing the impact of hyaluronic acid (HA) in reducing adverse events in patients taking hypertonic saline (HS) for CF were included in the analysis. Outcomes of interest included cough, throat irritation, unpleasant taste, and FEV1. Evaluations were reported as risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CI). The Cochrane Risk of Bias Tool (CRBT) was employed to assess the quality of RCTs. The New Castle Ottawa Scale was used to assess the quality of observational studies. RESULTS: From the 1960 articles retrieved from the initial search, five relevant studies (n=236 patients) were included in the final analysis. Compared with patients only on HS, patients with HS and HA were significantly less likely to experience cough (RR: 0.45; 95% CI, 0.28–0.72, p=0.001), throat irritation (RR: 0.43; 95% CI, 0.22–0.81, p= 0.009), and unpleasant smell (RR: 0.43; 95% CI, 0.23 – 0.80, p=0.09). In addition, patients with HS with HA had significantly less forced expiratory volume (FEV1) (MD: -2.97; 95% CI, -3.79—2.15, p=0.52) compared to patients only on HS. DISCUSSION: The addition of HA to HS was linked to a better tolerability profile. When HS was coupled with HA, there was a reduction in all side effects. This may permit tolerance of the medication in otherwise difficult patients, improve adherence to patients receiving frequent inhalations, and improve therapeutic outcomes. CONCLUSION: The addition of HA is advantageous in CF patients who require continuous HS therapy and have previously shown poor tolerance to therapy. Canadian Society of Respiratory Therapists 2023-10-31 /pmc/articles/PMC10621800/ /pubmed/37927455 http://dx.doi.org/10.29390/001c.89093 Text en https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (4.0) (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Review Article
Arshid, Sana
Ullah, *Saad Ehsan
Imran, Junaid
Syed, Meeran Asher
Choradia, Aakash
Gousy, Nicole
Boparai, Sukhman
Shoaib, Mudassir
Shah, Bidhan Bikram
Netha, Aadarsh
The effectiveness of hyaluronic acid in reducing adverse effects associated with inhaled hypertonic saline therapy in patients with cystic fibrosis: A systematic review and meta-analysis
title The effectiveness of hyaluronic acid in reducing adverse effects associated with inhaled hypertonic saline therapy in patients with cystic fibrosis: A systematic review and meta-analysis
title_full The effectiveness of hyaluronic acid in reducing adverse effects associated with inhaled hypertonic saline therapy in patients with cystic fibrosis: A systematic review and meta-analysis
title_fullStr The effectiveness of hyaluronic acid in reducing adverse effects associated with inhaled hypertonic saline therapy in patients with cystic fibrosis: A systematic review and meta-analysis
title_full_unstemmed The effectiveness of hyaluronic acid in reducing adverse effects associated with inhaled hypertonic saline therapy in patients with cystic fibrosis: A systematic review and meta-analysis
title_short The effectiveness of hyaluronic acid in reducing adverse effects associated with inhaled hypertonic saline therapy in patients with cystic fibrosis: A systematic review and meta-analysis
title_sort effectiveness of hyaluronic acid in reducing adverse effects associated with inhaled hypertonic saline therapy in patients with cystic fibrosis: a systematic review and meta-analysis
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10621800/
https://www.ncbi.nlm.nih.gov/pubmed/37927455
http://dx.doi.org/10.29390/001c.89093
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