• Evanirso Silva Aquino, Francine Shimura, Adriana Silveira Santos, Goto Danielle Miyuki DM, Cristiane Cenachi Coelho, Marcelo Bicalho de Fuccio, Paulo Hilario Nascimento Saldiva, Geraldo Lorenzi-Filho, Bruce K Rubin, and Nakagawa Naomi Kondo NK.
• Hospital Infantil João Paulo II, Universidade Católica de Minas Gerais, Minas Gerais, Brazil.
• Resp Care. 2012 Nov 1; 57 (11): 1914-9.

BackgroundPositive expiratory pressure (PEP) is used for airway clearance in cystic fibrosis (CF) patients. Hypertonic saline (HTS) aerosol increases sputum expectoration volume and may improve respiratory secretion properties. CPAP may also be used to maintain airway patency and mobilize secretions. To evaluate if CPAP would increase the beneficial clearance effect of HTS in subjects with CF, we investigated the effects of CPAP alone and CPAP followed by HTS on sputum physical properties and expectoration volume in CF subjects.MethodsIn this crossover study, 15 CF subjects (mean age 19 y old) were randomized to interventions, 48 hours apart: directed coughs (control), CPAP at 10 cm H(2)O, HTS 7%, and both CPAP and HTS (CPAP+HTS). Sputum collection was performed at baseline and after interventions. Expectorated volume was determined and in vitro sputum properties were analyzed for contact angle and cough clearability.ResultsThere were no significant differences between any treatment in arterial blood pressure, heart rate, or pulse oximetry, between the 2 time points. HTS and CPAP+HTS improved cough clearability by 50% (P = .001) and expectorated volume secretion by 530% (P = .001). However, there were no differences between control and CPAP on sputum contact angle, cough clearability, or volume of expectorated secretion.ConclusionsCPAP alone had no effect on mucus clearance, sputum properties, or expectorated volume, and did not potentiate the effect of HTS alone in CF subjects.

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