Good scientific evidence
- Music therapy
: Music is an ancient tool of healing that was recognized in the writings of Pythagoras, Aristotle, and Plato. Today, music is used to influence physical, emotional, cognitive, and social well-being, as well as to improve the quality of life for healthy, disabled, or sick people. It may involve either listening to or performing music, with or without the presence of a music therapist. Routine chest physiotherapy (CPT) is a component of preventative therapy in children with cystic fibrosis, which requires significant time and energy. There is some evidence that music therapy may be of benefit in children's tolerance and enjoyment of physiotherapy for cystic fibrosis. Music therapy is generally known to be safe.
Unclear or conflicting scientific evidence
- Beta-carotene
: Beta-carotene is a member of the carotenoids, which are very colorful (red, orange, yellow) fat-soluble compounds. They are naturally found in many fruits, grains, oil, and vegetables, such as green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers. Individuals with cystic fibrosis may be deficient in beta-carotene and vitamin E and it has been suggested that they may be more susceptible to oxidative damage. Theoretically, these patients may benefit from beta-carotene supplementation. Further research is needed before a conclusion can be drawn. - Avoid if sensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products.
- Borage seed oil
: Borage (Borago officinalis) is an herb native to Syria that has spread throughout the Middle East and Mediterranean. Borage flowers and leaves may be eaten and borage seeds are often pressed to produce oil that is very high in gamma-linolenic acid (GLA). Preliminary study suggests that borage oil may have some benefits for patients with cystic fibrosis. Although there are also some preliminary studies using other types of oils (e.g. fish oil), more research is needed to truly evaluate the benefits of using supplemental oils in this patient population. - Avoid if allergic or hypersensitive to borage, its constituents, or members of the Boraginaceae family. Use cautiously with bleeding disorders or if taking warfarin or other anticoagulant or anti-platelet (blood thinning) agents. Use cautiously with epilepsy or if taking anticonvulsants. Avoid in patients with compromised immune systems or similar immunological conditions. Avoid if pregnant because borage oil may be contraindicated in pregnancy given the teratogenic and labor-inducing effects of prostaglandin E agonists, such as borage oil's GLA. Avoid if breastfeeding.
- Massage
: Early evidence suggests that parent-administered massage may benefit mood and air flow in children with cystic fibrosis. - Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
- Nasal irrigation
: Nasal irrigation is used to clear the sinuses. Yoga enthusiasts have used nasal irrigation for thousands of years to clear both the sinus cavity and the mind. It can be performed by the patient at home or by a professional up to twice daily. There are three forms of nasal irrigation therapies. Saline lavage uses a warm liquid solution, while large-particle nebulized aerosol therapy uses aerosolized saline solution. A humidified warm air lavage (hyperthermia) may also be used. Occasionally, antibiotics are added to the solution. Chronic rhinosinusitis and progressive lung disease are extremely common in patients with cystic fibrosis. Case studies support the usage of nasal irrigation to improve lung function in cystic fibrosis patients. Another study suggests that nasal irrigation may be beneficial for cystic fibrosis patients who undergo endoscopic surgery. However, further research is needed before to confirm these findings. - Nasal irrigation is generally well tolerated. Use cautiously with a history of frequent nosebleeds. If the irrigation liquid is hot, the nose may become irritated.
- Omega-3 fatty acids, fish oil, alpha-linolenic acid
: Omega-3 fatty acids are found in fish oil and certain plant/nut oils. It remains unclear whether or not omega-3 fatty acids are beneficial for patients with cystic fibrosis. Further research in this area is warranted. - Avoid if allergic to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid, or omega-3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure, or if taking drugs, herbs, or supplements that treat any such conditions. Use cautiously before surgery. The Environmental Protection Agency (EPA) recommends that fish intake be limited in pregnant and breastfeeding women to a single six-ounce meal per week and less than two ounces per week in young children. For farm-raised, imported, or marine fish, the U.S. Food and Drug Administration (FDA) recommends that pregnant or breastfeeding women and young children avoid eating types with higher levels of methylmercury and less than 12 ounces per week of other fish types. Women who might become pregnant are advised to eat seven ounces or less per week of fish with higher levels of methylmercury or up to 14 ounces per week of fish types with about 0.5 parts per million (such as marlin, orange roughy, red snapper, or fresh tuna).
- Physical therapy
: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. Many techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used. A technique called chest physical therapy (postural drainage, percussion, and vibration) has been used for clearance of bronchial secretions in cystic fibrosis, with or without mechanical devices, such as the Flutter valve. However, well-designed studies are lacking. Additional research is needed in this area - Not all physical therapy programs are suited for everyone and patients should discuss their medical histories with their qualified healthcare professionals before beginning any treatments. Based on the available literature, physical therapy generally appears safe when practiced by a qualified physical therapist. However, complications are possible. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature, although causality is unclear. Erectile dysfunction has also been reported. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
- Safflower
: In the United States, safflower oil has been frequently substituted for oils with higher saturated fat content because it may have a beneficial effect on the risk of coronary heart disease. Safflower oil may be taken by mouth, injected into a vein, or applied to the skin. Cystic fibrosis patients are frequently deficient in fatty acids due to reduced absorption of nutrients. Results from studies using safflower oil supplements are mixed. Additional study is needed. - Avoid if allergic or hypersensitive to safflower, Carthamus tinctorius, safflower oil, daisies, ragweed, chrysanthemums, marigolds, or any related constituents. Use parenteral safflower oil emulsions cautiously in newborns. Use cautiously if taking anticoagulants (blood thinners) or anti-platelet drugs, immunosuppressants, or pentobarbital. Use cautiously with diabetes, hypotension, inadequate liver function, hypercoagulability, and skin pigmentation conditions. Use cautiously if pregnant or breastfeeding.
- Selenium
: Selenium is a mineral found in soil, water, and some foods. Early research suggests that selenium supplements may help treat cystic fibrosis. However, further research is needed before a firm conclusion can be drawn. - Avoid if allergic or hypersensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
- Taurine
: Taurine is found in high abundance in the tissues of many animals, especially sea animals, and in much lower concentrations in plants, fungi, and some bacteria. Taurine has been suggested as a possible treatment for cystic fibrosis because it may increase the effects of ursodeoxycholic acid (UDCA), as well as nutritional status. However, results are mixed. More research is needed to drawn a firm conclusion in this area. - Because taurine is an amino acid, it is unlikely that there are allergies related to this constituent. However, allergies may occur from multi-ingredient products that contain taurine. Use cautiously with high VLDL cholesterol, hypertriglyceridemia, a history of low blood pressure, coagulation disorders, potential for mania, or epilepsy. Use cautiously if taking hypolipidemic medications, or hypotensive, hypoglycemic, anti-platelet or anticoagulant medications. Avoid consumption of energy drinks containing taurine, caffeine, glucuronolactone, B vitamins, or other ingredients and then consuming alcohol or exercising. Use cautiously if pregnant or breastfeeding; taurine is a natural component of breast milk. Taurine at a concentration of five millimolars per liter has been shown to support the development of human embryos (blastocyte stage) in vitro.
Fair negative scientific evidence
: Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Zinc supplements do not seem to affect overall health, growth velocity, or lung function in cystic fibrosis in children.- Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.