We read with interest the article by Cimmino et al1 in the December 2005 issue of the Archives. The authors concluded that dornase alfa is superior to placebo (saline in this study) for the treatment of patients with cystic fibrosis and nasal symptoms. However, we think that the use of isotonic saline solution as placebo is inappropriate. It is well known that nasal washing with saline solution facilitates nasal drainage and cleans the airway of any postnasal discharge; it can be effective when applied appropriately (5 dropperfuls in each nostril at least 4 times a day).2,3 Saline solution irrigation has been found to reduce inflammatory mediators (histamine, prostaglandin D2, and leukotriene C4) and allergens in nasal secretions.4 Therefore, nasal saline washing with the correct technique is a cheap and effective method for treating inflammatory conditions of the upper respiratory tract such as the common cold, acute and chronic sinusitis, and chronic rhinitis.2,4 Given all these factors, we believe that nasal saline washing with the correct technique can be as effective as treatment with dornase alfa; therefore, it should not be used as a placebo in this type of study.
Acar B, Karabulut H. Sinonasal Disease and Nasal Saline. Arch Otolaryngol Head Neck Surg. 2007;133(6):625. doi:10.1001/archotol.133.6.625-a