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

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.

Conflict of interest statement

Conflict of Interest: The authors except JZ do not have any conflicts of interest to report

Published by Elsevier B.V.

Figures

Figure 1:

Distribution of lung function, body mass index (BMI) and white blood cell (WBC) count in the pre- and post-intervention periods in the two treatment groups. * Statistically significant mean difference from baseline within group at a significance level of 0.05.

Figure 2:

A Kaplan-Meier plot of the proportion of subjects that remained free of exacerbation in the inhaled hypertonic saline (blue) and xylitol (red) treatment groups. Time to next exacerbation was not statistically different between the two groups (log rank, p value = 0.36).