Date	Event	Description
11 September 2018	New search has been performed	A major update of the review was conducted with 90 new references identified from searches of the Cochrane Cystic Fibrosis and Genetic Disorders Trials Register, clinicaltrials.gov and the WHO ICTRP. New trials Five important new trials (24 references) have been included (Amin 2010; Dentice 2016; Laube 2009; Mainz 2015; Rosenfeld 2012). This increased the number of participants in the trial from 442 to 966. Nine new trials (27 references) have also been excluded (Brivio 2016; Buonpensiero 2010; DeCono 2008; Dentice 2012; EUCTR2007‐002707‐40‐BE; Grasemann 2013; IRCT20180307038994N1; NCT01094704; O'Neill 2017; Ros 2012; San Miguel 2016; Van Ginderdeuren 2008; Van Ginderdeuren 2011). 16 newly identified trials (21 references) are currently awaiting assessment until further information is available to allow inclusion or exclusion (Amin 2016; Balinotti 2015; Brown 2010; Corcoran 2017; Donaldson 2013; Dwyer 2013; Hofmann 1997; NCT00928135; NCT01355796; NCT01377792; NCT01619657; NCT02378467; NCT03391414; Nenna 2017; Palacio 2014; PRESIS 2018). Three new trials (four references) are listed as ongoing (NCT02276898; NCT02343445; NCT02950883). Previously identified trials 11 additional references have been added to five already included trials (Elkins 2006a; Eng 1996; Robinson 1997; Robinson 1999; Weller 1980). One additional reference has been added to an already excluded trial (Donaldson 2006). Two trials (two references) which were previously listed as 'Awaiting classification' have been excluded (Elkins 2006b; Vanlaethem 2008). An additional reference to the Elkins trial was identified in the latest searches. One trial (one reference) previously excluded has been moved to 'Awaiting classification' pending further information (Hofmann 1997).
11 September 2018	New citation required and conclusions have changed	The conclusions have been amended in light of the new evidence. The addition of new data has allowed us to conclude that hypertonic saline appears to be an effective adjunct to physiotherapy during acute exacerbations of lung disease in adults.