***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Beneficial effects of hypertonic saline on lung function in cystic fibrosis patients are well documented . However , the effects of various concentrations of hypertonic saline are not well studied . We , therefore , compared the effects of 3 and 7 % hypertonic saline administered by nebulization on lung function in children with cystic fibrosis . METHOD In a double-blind r and omized controlled trial , 31 children with cystic fibrosis were r and omized to receive either 3 % saline or 7 % saline nebulization twice daily for 28 days . Spirometry was performed and functional status was measured on Day 14 and 28 . RESULTS Of 31 children enrolled in the study , 30 completed the 28 days follow up ( 15 in each group ) . Percentage change in Forced Expiratory Volume during first second ( FEV(1 ) ) from baseline to Day 14 and on Day 28 was significantly higher in the group receiving 3 % saline as compared with those receiving 7 % saline inhalation . There was some decrease in FEV(1 ) ( percentage predicted ) immediately after 7 % saline inhalation unlike 3 % saline . The functional status remained comparable between the two groups . CONCLUSION The results suggest that 3 % hypertonic saline nebulization was better than 7 % saline inhalation . There is a need for studies with larger sample size and longer duration to confirm our results Background The mucoactive effects of hypertonic saline should promote exacerbation resolution in people with cystic fibrosis ( CF ) . Objectives To determine the effects of hypertonic saline inhalation during hospitalisation for exacerbation of CF on length of stay , lung function , symptoms , oxygenation , exercise tolerance , quality of life , bacterial load and time to next hospitalisation . Methods 132 adults with an exacerbation of CF were r and omised to inhale three nebulised doses a day of either 4 mL 7 % saline or a taste-masked control of 0.12 % saline , throughout the hospital admission . The primary outcome measure was length of hospital stay . Results All participants tolerated their allocated saline solution . There was no significant difference in length of stay , which was 12 days in the hypertonic saline group and 13 days in controls , with a mean between-group difference ( MD ) of 1 day ( 95 % CI 0 to 2 ) . The likelihood of regaining pre-exacerbation FEV1 by discharge was significantly higher in the hypertonic saline group ( 75 % vs 57 % ) , and the number needed to treat was 6 ( 95 % CI 3 to 65 ) . On a 0–100 scale , the hypertonic saline group had significantly greater reduction in symptom severity than the control group at discharge in sleep ( MD=13 , 95 % CI 4 to 23 ) , congestion ( MD=10 , 95 % CI 3 to 18 ) and dyspnoea ( MD=8 , 95 % CI 1 to 16 ) . No significant difference in time to next hospitalisation for a pulmonary exacerbation was detected between groups ( HR=0.86 ( CI 0.57 to 1.30 ) , p=0.13 ) . Other outcomes did not significantly differ . Conclusions Addition of hypertonic saline to the management of a CF exacerbation did not reduce the length of hospital stay .  Hypertonic saline speeds the resolution of exacerbation symptoms and allows patients to leave hospital with greater symptom resolution . Trial registration number ACTRN12605000780651 Our goal was to assess the role of early childhood vaccination in the occurrence of respiratory symptoms and allergic sensitization in 7 - 8-year-old Dutch and German children . A nested case-control study was conducted among children participating in a large longitudinal study on respiratory health , to study the relationship between vaccination ( bacille Calmette-Guérin ( BCG ) , pertussis , measles/mumps , rubella , and Haemophilus influenza type b ( Hib ) ) and respiratory symptoms and allergic sensitization .  Parents of 510 7 - 8-year-old children with respiratory complaints and an equal number of r and omly selected children without respiratory complaints were asked to complete a question naire . Blood sample s were collected for specific serum IgE analysis . Vaccination status was assessed through the records of the participating Municipal Health Services . No association between vaccination against pertussis , measles , rubella , or Hib and respiratory symptoms or allergic sensitization was found . For sensitization against house dust mite ,  BCG vaccination result ed in an increased risk ( OR , 2.28 ; 95 % CI , 1.05 - 4.96 ) . Birth order was inversely associated with allergic sensitization , but was not related to respiratory symptoms . We found an association between  BCG vaccination  and the subsequent risk for sensitization against house dust mite . No evidence was found for an association between vaccination and respiratory symptoms . Earlier reports of an association of birth order with atopic disease were supported by the results of the present study BACKGROUND Chronic rhinosinusitis is a hallmark of Cystic fibrosis ( CF ) impairing the patients ' quality of life and overall health . However , therapeutic options have not been sufficiently evaluated . Bronchial inhalation of mucolytic substances is a gold st and ard in CF therapy . Previously , we found that sinonasal inhalation of dornase alfa as vibrating aerosol reduces symptoms of chronic rhinosinusitis more effectively than NaCl 0.9 % ( net treatment benefit : -5.87±2.3 points , p=0.017 ; SNOT-20 total score ) . This multicenter study compares the effect of NaCl 6.0 % vs. NaCl 0.9 % following the protocol from our preceding study with dornase alfa . METHODS Sixty nine CF patients with chronic rhinosinusitis in eleven German CF centers were r and omized to receive sinonasal vibrating inhalation of either NaCl 6.0 % or NaCl 0.9 % for 28days . After 28days of wash-out , patients crossed over to the alternative treatment . The primary outcome parameter was symptom score in the disease-specific quality of life Sino-Nasal Outcome Test-20 ( SNOT-20 ) . Additionally , pulmonary function was assessed , as well as rhinomanometry and inflammatory markers in nasal lavage ( neutrophil elastase , interleukin (IL)-1β , IL-6 , and IL-8 ) in a subgroup . RESULTS Both therapeutic arms were well tolerated and showed slight improvements in SNOT-20 total scores  ( NaCl 6.0 % : -3.1±6.5 points , NaCl 0.9 % : -5.1±8.3 points , ns ) . In both treatment groups , changes of inflammatory parameters in nasal lavage from day 1 to day 29 were not significant . We suppose that the irritating properties of NaCl 6.0 % reduced the suitability of the SNOT-20 scores as an outcome parameter . Alternative primary outcome parameters such as MR-imaging or the quantity of sinonasal secretions mobilized with both saline concentrations were , however , not feasible . CONCLUSION Sinonasal inhalation with NaCl 6.0 % did not lead to superior results vs. NaCl 0.9 % , whereas dornase alfa had been significantly more effective than NaCl 0.9 % Background Streamlining the timing of treatments in cystic fibrosis ( CF ) is important to optimise adherence while ensuring efficacy . The optimal timing of treatment with hypertonic saline ( HTS ) and airway clearance techniques ( ACT ) is unknown . Objectives This study hypothesised that HTS before ACT would be more effective than HTS during ACT as measured by Lung Clearance Index ( LCI ) . Methods Adults with CF providing written informed consent were r and omised to a crossover trial of HTS before ACT or HTS during ACT on consecutive days . ACT treatment consisted of Acapella Duet . Patients completed LCI and spirometry at baseline and 90 min post treatment . Mean difference ( MD ) and 95 % CIs were reported . Results 13 subjects completed the study ( mean ( SD ) age 33 ( 12 ) years , forced expiratory volume in 1second % ( FEV1 % ) predicted 51 % ( 22 ) , LCI ( no. turnovers ) 14 ( 4 ) ) . Comparing the two treatments ( HTS before ACT vs HTS during ACT ) , the change from baseline to 90 min post treatment in LCI ( MD ( 95 % CI ) −0.02 ( −0.63 to 0.59 ) ) and FEV1 % predicted ( MD ( 95 % CI ) −0.25 ( −2.50 to 1.99 ) ) was not significant . There was no difference in sputum weight ( MD ( 95 % CI ) −3.0 ( −14.9 to 8.9 ) ) , patient perceived ease of clearance ( MD ( 95 % CI ) 0.4 ( −0.6 to 1.3 ) or satisfaction ( MD ( 95 % CI ) 0.4 ( −0.6 to 1.5 ) ) . The time taken for HTS during ACT was significantly shorter ( MD ( 95 % CI ) 14.7 ( 9.8 to 19.6 ) ) . Conclusions In this pilot study , HTS before ACT was no more effective than HTS during ACT as measured by LCI . Trial registration number NCT01753869 ; Pre- results BACKGROUND Inhaled hypertonic saline acutely increases mucociliary clearance and , in short-term trials , improves lung function in people with cystic fibrosis . We tested the safety and efficacy of inhaled hypertonic saline in a long-term trial . METHODS In this double-blind , parallel-group trial , 164 patients with stable cystic fibrosis who were at least six years old were r and omly assigned to inhale 4 ml of either 7 percent hypertonic saline or 0.9 percent ( control ) saline twice daily for 48 weeks , with quinine sulfate ( 0.25 mg per milliliter ) added to each solution to mask the taste . A bronchodilator was given before each dose , and other st and ard therapies were continued during the trial . RESULTS The primary outcome measure , the rate of change ( slope ) in lung function ( reflected by the forced vital capacity [ FVC ] , forced expiratory volume in one second [ FEV1 ] , and forced expiratory flow at 25 to 75 percent of FVC [ FEF25 - 75 ] ) during the 48 weeks of treatment , did not differ significantly between groups ( P=0.79 ) . However , the absolute difference in lung function between groups was significant ( P=0.03 ) when averaged across all post-r and omization visits in the 48-week treatment period . As compared with the control group , the hypertonic-saline group had significantly higher FVC ( by 82 ml ; 95 percent confidence interval , 12 to 153 ) and FEV1 ( by 68 ml ; 95 percent confidence interval , 3 to 132 ) values , but similar FEF25 - 75 values . The hypertonic-saline group also had significantly fewer pulmonary exacerbations ( relative reduction , 56 percent ; P=0.02 ) and a significantly higher percentage of patients without exacerbations ( 76 percent , as compared with 62 percent in the control group ; P=0.03 ) . Hypertonic saline was not associated with worsening bacterial infection or inflammation . CONCLUSIONS Hypertonic saline preceded by a bronchodilator is an inexpensive , safe , and effective additional therapy for patients with cystic fibrosis . ( Clinical Trials.gov number , NCT00271310 . BACKGROUND : Positive 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 . METHODS : In this crossover study , 15 CF subjects ( mean age 19 y old ) were r and omized to interventions , 48 hours apart : directed coughs ( control ) , CPAP at 10 cm H2O , 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 . RESULTS : There 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 . CONCLUSIONS : CPAP alone had no effect on mucus clearance , sputum properties , or expectorated volume , and did not potentiate the effect of HTS alone in CF subjects BACKGROUND Cystic fibrosis ( CF ) airways are nitric oxide ( NO ) deficient . We studied safety and efficacy of repeated inhalations of nebulized L-arginine , the substrate for NO synthase ( NOS ) , in patients with CF . METHODS Double-blind , r and omized , place 
    Output:
    
The effects of the various regimens on lung function were non-significant .
People with cystic fibrosis could be encouraged to inhale hypertonic saline before or during airway clearance techniques to maximise perceived efficacy and satisfaction , even though these timing regimens may not have any better effect on lung function than inhalation after airway clearance techniques .