Advances in Therapy

, Volume 27, Issue 11, pp 870–878 | Cite as

Hyaluronic acid improves “pleasantness” and tolerability of nebulized hypertonic saline in a cohort of patients with cystic fibrosis

  • Paolo BuonpensieroEmail author
  • Fabiola De Gregorio
  • Angela Sepe
  • Antonio Di Pasqua
  • Pasqualina Ferri
  • Maria Siano
  • Vito Terlizzi
  • Valeria Raia
Original Research



Inhaled hypertonic saline improves lung function and decreases pulmonary exacerbations in people with cystic fibrosis. However, side effects such as cough, narrowing of airways and saltiness cause intolerance of the therapy in 8% of patients. The aim of our study was to compare the effect of an inhaled solution of hyaluronic acid and hypertonic saline with hypertonic solution alone on safety and tolerability.


A total of 20 patients with cystic fibrosis aged 6 years and over received a single treatment regimen of 7% hypertonic saline solution or hypertonic solution with 0.1% hyaluronate for 2 days nonconsecutively after a washout period in an open crossover study. Cough, throat irritation, and salty taste were evaluated by a modified ordinal score for assessing tolerability; “pleasantness” was evaluated by a five-level, Likert-type scale. Forced expiratory volume in 1 second was registered before and after the end of the saline inhalations.


All 20 patients (nine males, 11 females, mean age 13 years, range 8.9–17.7) completed the study. The inhaled solution of 0.1% hyaluronic acid and hypertonic saline significantly improved tolerability and pleasantness compared to hypertonic saline alone. No major adverse effects were observed. No difference was documented in pulmonary function tests between the two treatments.


Hyaluronic acid combined with hypertonic saline solution may contribute to improved adherence to hypertonic saline therapy. Further clinical trials are needed to confirm our findings. Considering the extraordinary versatility of hyaluronic acid in biological reactions, perspective studies could define its applicability to halting progression of lung disease in cystic fibrosis.


cystic fibrosis hyaluronic acid hypertonic saline solution pleasantness tolerability 


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Copyright information

© Springer Healthcare 2010

Authors and Affiliations

  • Paolo Buonpensiero
    • 1
    Email author
  • Fabiola De Gregorio
    • 1
  • Angela Sepe
    • 1
  • Antonio Di Pasqua
    • 1
  • Pasqualina Ferri
    • 1
  • Maria Siano
    • 1
  • Vito Terlizzi
    • 1
  • Valeria Raia
    • 1
  1. 1.Department of PediatricsUniversity of Naples Federico IINaplesItaly

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