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J Cyst Fibros. 2019 Jul 18. pii: S1569-1993(19)30821-5. doi: 10.1016/j.jcf.2019.06.016. [Epub ahead of print]

Randomized controlled study of aerosolized hypertonic xylitol versus hypertonic saline in hospitalized patients with pulmonary exacerbation of cystic fibrosis.

Author information

1
Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.
2
Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.
3
Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA 52242, USA.
4
Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
5
Doris Duke Clinical Research Scholar, University of Iowa, USA.
6
Department of Pediatrics, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA.
7
Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA. Electronic address: lakshmi-durairaj@uiowa.edu.

Abstract

BACKGROUND:

Cystic fibrosis (CF) lung disease is characterized by chronic bacterial infection and recurrent pulmonary exacerbations. Xylitol is a 5-carbon sugar that can lower the airway surface salt concentration and augment innate immunity. We examined the safety and efficacy of aerosolized xylitol use for 2 weeks in subjects hospitalized with a pulmonary exacerbation of CF.

METHODS:

In a 2-week study, 60 subjects with cystic fibrosis and FEV1 > 30% predicted were enrolled to receive aerosolized 7% hypertonic saline (4 ml) or 15% xylitol (5 ml) twice a day for 14 days. Outcomes assessed included change from baseline in FEV1% predicted, change in sputum microbial density, revised CF quality of life questionnaire including the respiratory symptom score, time to next hospitalization for a pulmonary exacerbation, and frequency of adverse events.

RESULTS:

59 subjects completed the study (one subject in the saline group withdrew before any study product administration). No significant differences were noted between the 2 arms in mean changes in lung function, sputum microbial density for Pseudomonas aeruginosa and Staphylococcus aureus, body weight, quality of life, and frequency of adverse events.

CONCLUSIONS:

Aerosolized hypertonic xylitol was well-tolerated among subjects hospitalized for CF pulmonary exacerbation. Future studies examining efficacy for long term use in patients with CF lung disease would be worthwhile. The clinical trial registration number for this study is NCT00928135.

KEYWORDS:

Exacerbations; Lung function; Quality of life; Respiratory symptom score; Sputum microbial density

PMID:
31327670
DOI:
10.1016/j.jcf.2019.06.016

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