The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

PROTOCOLS FOR INHALED HYPERTONIC SALINE OR RHDNASE FOR PATIENTS WITH CYSTIC FIBROSIS

C. A. Denear1, S. Kindel1

Background: UCSD Thornton Hospital is a 119 bed facility with a Cystic Fibrosis(CF) center treating approximately 115 adult CF patients per year. In January 2007 an assessment protocol was implemented to provide appropriate care plans. In the past, rhDNase(DN) was the primary inhaled medication used to decrease secretion viscosity. We experienced situations in which DN was not effective, resulted in undesired effects, or was considered too costly. We determined the use of 7% hypertonic saline(HS) as a viable alternative. We developed a protocol to introduce the use of HS in conjunction with DN.

Method: A multidisciplinary team was formed and met bi-weekly over 3 months to develop evidence based protocols for all aspects of CF care including the use of HS in secretion management. The protocol specifies that 2.5 mg of DN be administered once daily via nebulizer before chest physiotherapy with 4 mls of 7% HS administered twice daily. A bronchodilator is administered before the HS and pre and post peak flows are recorded. If there is an adverse reaction, the treatment is stopped and the doctor notified. Patients are encouraged to continue the HS treatments in their home regime to decrease pulmonary exacerbations and increase lung function.

Results: Since January 2007, we have had 46 CF admissions. The protocols were successfully implemented and protocol patients were observed to have increased sputum production and fewer exacerbations resulting in fewer hospitalizations and fewer missed treatments. The direct variable cost of a single rhDNase treatment is $46, in comparison to the HS treatment cost of $9.37 and thus cost effective. Patients who were unable to tolerate rhDNase had the option to use HS. We have had no reports of adverse effects to the HS.

Conclusion: Nebulized DN and HS are both effective in secretion management and result in increased sputum production and fewer exacerbations in patients with cystic fibrosis. Hypertonic saline is a viable addition to a patient’s regime, however we have found through the research available that it is not more effective than rhDNase alone. UCSD will continue to evaluate the merit of the CF protocols in the hospital and CF clinic.

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